After a GP trainee fails a high-stakes clinical exam required to complete GP training in the UK, what can the video of their consultations do for them? The Royal College of General Practitioners states that Simulated Consultation Assessment recordings are used by examiners to mark the exam. It also states that they will not be remarked as part of an appeal and will not routinely be retained beyond the examination diet.
Research gives good reasons not to treat video as an objective witness. But it leaves a narrower question unanswered: when examiner prejudice or bias is a permitted ground for appeal, what evidentiary role can the recording play?
A recorded exam with no route to a second mark
Since November 2023, the Simulated Consultation Assessment has played a decisive role in whether trainees complete GP training in the UK. Each candidate completes twelve remote consultations, which are recorded and marked. In the first reporting period, from November 2023 to June 2024, there were 5,582 sittings.
RCGP’s appeals policy allows two principal grounds: a procedural or logistical irregularity, or “evidence of prejudice or bias on the part of the examiner(s).” Feeling undermarked, disagreeing with academic judgment and failing by a narrow margin are excluded.
Even when alleged bias falls within scope, the published terms rule out remarking the recording. A Stage 1 review can correct calculation or collation errors. If a Stage 2 appeal is upheld, a panel may void the attempt, authorize a fee-free resit or offer other redress, but the original performance does not receive a second mark.
That distinction is defensible. Correcting an administrative error is not the same as reopening academic judgment. What is less clear from the public documents is whether, and how, the recording may be examined as evidence while an allegation of bias is investigated.
A second mark is not a simple replay
The case against automatic video remarking deserves to be taken seriously. A 2019 University of Manchester study reviewed eight comparisons of live and video-based OSCE marking. Results were inconsistent, with a tendency for live examiners to award higher scores. The authors concluded that using video to decide OSCE appeals was not supported by the evidence then available.
A 2020 study helps explain why. It followed 16 students and 14 examiners across ten iterations of simulated OSCE stations. Video examiners felt more detached and had less control over what they could see. Camera angle, sound, lighting and the clinical task determined whether important information was available. Missing details could invite inferences that biased the judgment.
Those findings rule out the comforting idea that pressing play produces a neutral second opinion. Any review process would need to be designed and validated for its specific purpose.
They do not resolve the SCA question. Earlier research largely asked whether video could reproduce a judgment made by an examiner who was physically present. In the SCA, video is already the medium used for the original mark. A second examiner would review the same recorded performance on which the first judgment was based.
The risk does not disappear. A reviewer who knows a candidate has appealed may scrutinize the performance differently. That is a reason to design a controlled protocol, not to leave the recording’s role undefined.
The numbers make reviewability matter
RCGP’s own figures for November 2023 to June 2024 show that UK medical graduates passed the SCA at 94.27%, compared with 51.52% for international medical graduates. Black, Asian and ethnic minority UK graduates passed at 90.80%, compared with 96.67% for white UK graduates.
Those gaps do not prove examiner bias. A 2025 British Journal of General Practice study of 28,020 MRCGP candidates linked attainment to the language context of undergraduate training. In the Recorded Consultation Assessment, the SCA’s predecessor, fully adjusted odds ratios for passing were 0.36 for international graduates whose degree was taught in English in a non-English-first-language country, and 0.26 for those whose degree was not taught in English, compared with UK graduates.
The authors pointed to linguistic and cultural factors and recommended tailored support. They did not test examiner bias. The findings show why group-level statistics cannot settle an individual appeal: an explanation for a population gap cannot determine whether one candidate was judged fairly.
Not just an exam problem
The governance question extends beyond GP licensing. A 2024 Freedom of Information study received responses from 140 of 144 acute NHS trusts and boards in England and Wales. Only 59 of 140 had a governance policy covering the recording, use or storage of surgical video. Policies governing surgeon access existed in 48, and patient access in 32.
Surgical care and clinical examinations are different settings. The common problem is purpose. A recording may be created for one reason, retained for another and treated as unavailable for a third. Unless those roles are established in advance, the presence of video can create an impression of accountability without a defined route to use it.
What a defensible policy would clarify
RCGP does not need to promise a full remark to every unsuccessful candidate. It should state whether recordings can be consulted when an appeal alleges prejudice, bias or a procedural irregularity, who may review them and what that reviewer is permitted to decide.
It should retain relevant recordings until the review and appeal window has closed, rather than making the end of the examination diet the default boundary. It should also test and publish the reliability of any review method, including whether independent examiners reach stable judgments from the same recordings and how knowledge of the original result is controlled.
This would preserve the boundary around routine academic judgment while giving the recording a role in the exceptional cases the appeals policy already recognizes.
The window is now
Results from the September SCA diet are scheduled for 20 October. Candidates then have ten working days to request a Stage 1 review.
The question is not whether a camera makes assessment objective. It does not. The question is whether an examination built around recorded evidence can explain, before the next appeal arrives, exactly what that evidence is allowed to prove.
Author biography:
Dr. Mahé Pereira is a general practitioner and Product Manager at Videolab, where she works on video-based tools for medical education; from skills-lab training to OSCE and simulated consultation workflows. She brings a clinical background to questions of how assessment infrastructure is designed, governed, and used in practice.
Here is her linkedin profile: https://www.linkedin.com/in/mahepereira/
