LESSON 1.4: The Three Marking Domains — How You Are Assessed

Every case is marked across three domains. Understanding these domains deeply is the single most important thing you can do for your preparation. The examiner awards one of four grades per domain per case:

1. Clear Pass (CP): Clearly above the standard of a newly qualified, independent GP
2. Pass (P): At the standard of a newly qualified, independent GP
3. Fail (F): Insufficiently demonstrated at the standard
4. Clear Fail (CF): Clearly demonstrated below the standard

Domain 1: Data Gathering & Diagnosis

You must systematically gather and organise relevant, targeted information to address the patient’s needs, generating an appropriate differential diagnosis and relying on first principles when the presentation is undifferentiated or complex.

What examiners are looking for:

1. Systematic questioning targeted to the problem
2. Effective use of existing information (case notes, letters, results)
3. Red flag assessment — ruling in and ruling out serious disease
4. Psychosocial context — impact on patient’s life, work, relationships
5. Evidence-based diagnostic reasoning using probability and prevalence
6. Eliciting ICE (Ideas, Concerns, Expectations) naturally

Domain 2: Clinical Management & Medical Complexity

You must formulate safe, appropriate management options with effective prioritisation. This domain carries slightly more weight overall as it is linked to more capabilities.

What examiners are looking for:

1. Evidence-based, patient-centred management plans
2. Shared decision-making — involving the patient in choices
3. Appropriate prescribing (drug, dose, duration, monitoring, side effects)
4. Managing multi-morbidity and polypharmacy
5. Safety netting that is SMART (Specific, Measurable, Achievable, Relevant, Timely)
6. Appropriate follow-up and continuity planning
7. Resource stewardship — not over-investigating or over-referring
8. Tolerating and managing clinical uncertainty

Domain 3: Relating to Others

This domain runs throughout the entire consultation. Demonstrate ethical awareness, person-centred communication, initiative and flexibility to overcome communication barriers and reach shared understanding.

What examiners are looking for:

1. Building and maintaining rapport
2. Active listening — picking up verbal and non-verbal cues
3. Genuine empathy (not formulaic phrases)
4. Clear, jargon-free explanations
5. Cultural sensitivity and respect for autonomy
6. Ethics: consent, capacity, confidentiality
7. Adapting communication style to different patients