The SCE Geriatric Medicine is distinctive among the Specialty Certificate Examinations because it tests a holistic approach to the older patient rather than organ-system-specific knowledge. The curriculum emphasises comprehensive geriatric assessment, frailty, multimorbidity, polypharmacy, capacity assessment, and the interface between medical management and social care. The exam sits twice per year, typically February and September.
What makes it different
Most SCEs test depth within a single organ system. Geriatric medicine tests breadth across all organ systems but through the lens of the older patient — how does this diagnosis change when the patient is 85, frail, has five comorbidities, takes twelve medications, and lives alone? Questions frequently present a clinical scenario where the correct answer is not the textbook management of the primary condition but a nuanced decision that accounts for frailty, life expectancy, treatment burden, and patient preference.
This means candidates who prepare using only disease-specific revision — the approach that works for Cardiology or Respiratory — often underperform. You must also revise the frameworks specific to geriatric medicine: comprehensive geriatric assessment (CGA), Clinical Frailty Scale, delirium screening (4AT), capacity assessment (Mental Capacity Act 2005), deprescribing (STOPP/START criteria), and falls risk assessment.
Topic weighting
Falls and bone health account for roughly 14 per cent — falls risk assessment, multifactorial intervention, osteoporosis investigation and treatment (FRAX, NOGG thresholds, bisphosphonates, denosumab), hip fracture management, and secondary prevention. Delirium accounts for 10 per cent — recognition (4AT score), investigation (identifying the precipitant), non-pharmacological management, and the limited role of pharmacological intervention. Dementia accounts for 10 per cent — diagnosis (NICE NG97), acetylcholinesterase inhibitor prescribing, behavioural and psychological symptoms, capacity assessment, and advance care planning.
Frailty and CGA account for 10 per cent — the CGA framework, frailty screening tools, and the evidence base for CGA-driven interventions. Stroke and rehabilitation account for 8 per cent. Continence accounts for 6 per cent. Parkinson's disease in the older adult accounts for 8 per cent — with particular focus on levodopa management, on-off phenomena, medication review in advanced disease, and the overlap between Parkinson's disease dementia and dementia with Lewy bodies.
Polypharmacy and deprescribing account for 10 per cent — STOPP/START v2, anticholinergic burden assessment, and the practical approach to medication rationalisation. Palliative care, ethics, capacity, and legal frameworks account for 10 per cent — including the Mental Capacity Act 2005, Deprivation of Liberty Safeguards, best interests decisions, DNAR decision-making, and ceiling of treatment discussions.
The remaining questions cover perioperative care of the older adult, safeguarding, infection in older adults, nutrition and sarcopenia, and cardiovascular disease management in the context of frailty.
Mental Capacity Act
The Mental Capacity Act 2005 is tested in virtually every SCE Geriatric Medicine sitting. You must know the five principles, the two-stage capacity test, the definition of best interests, the role of an IMCA, the difference between lasting power of attorney (health and welfare versus property and finance), and the Deprivation of Liberty Safeguards framework. These are precise legal concepts and the exam expects precise answers.
Revision strategy
Three to four months. Divide your revision into clinical geriatric syndromes (falls, delirium, dementia, continence, polypharmacy, frailty) and cross-cutting frameworks (CGA, MCA, DOLS, STOPP/START, advance care planning). Both must be covered — questions test the frameworks as frequently as the clinical conditions.
iatroX's SCE Geriatric Medicine bank contains over 1,500 questions aligned to BGS guidelines, NICE, and the JRCPTB Geriatric Medicine curriculum. CGA and capacity assessment questions are tagged for focused practice. The adaptive algorithm ensures that cross-cutting topics like deprescribing and MCA receive appropriate revision time alongside organ-system conditions. All included at £29 per month or £99 per year.