Exam - Focus on key skills in MRCGP video

Develop your consulting skills before tackling the video module, says Dr Bob Mortimer.

For many GP registrars, the video is the MRCGP module that generates the most anxiety - in addition to consuming vast amounts of time having to sift through hours of recorded consultations. Here are a few tips to help you prepare your tape.

Assessment criteria

The aim of the MRCGP video is for the GP registrar to learn good communication skills. Do not forget that the performance criteria are developed for assessing a consultation, they are not a script for producing one.

Do not make the mistake of thinking that if you record enough consultations you are bound to find seven that are suitable; if you do this you will probably find that you spend hours watching recordings trying to find the 'good' consultations.

In my opinion it is far better to spend time thinking about what the examiners would like you to achieve in your consultations and learning the skills you need to get there.

Communication and involvement

The whole point of learning consulting skills is so that when a patient comes to see you, you are able to find out what is bothering them, apply your medical knowledge and clinical skills to formulate a diagnosis and then arrive at a mutually acceptable management plan.

This may sounds simple but patients do not always make it easy for the doctor. The precise nature of what is bothering them is not always the same as what they appear to present with. Patients might also have preconceived ideas about what might be causing their symptoms and what should be done about it.

Patients almost always do have some idea about what might be wrong before they come to see you but, if you ask directly, most will probably not give you a direct answer.

You need to develop your own techniques of generating sufficient trust for the patient to confide in you, for them to believe that you are genuinely interested and that you will not think their ideas are ridiculous.

It is as much about the relationship you establish with the patient as it is about the actual words you use. Often you can second-guess what the patient is thinking - in which case it is easy to prompt them if necessary.

You can practice all of this without a video camera, and you will know when it feels right and when it feels wrong. Once you feel comfortable with it you will be ready to capture it on your tape, but not before.

You are also required to give the patient the opportunity to be involved in significant management decisions. Beware, however, of offering inappropriate solutions - for example antibiotics for minor illnesses - or heavily weighting up descriptions such that the patient is really offered no choice. Examiners can also be irritated by candidates using stock phrases and cliches - try to avoid using the word 'options'.

Demonstrating a range of skills

The video is about demonstrating that you are a good consulter, so beware using follow-up consultations or relatively trivial ones. Choose a range of different cases offering a reasonable level of challenge.

Candidates frequently cover the lens to avoid filming a physical examination.

While this is quite acceptable where there is some degree of intimate examination, the examiner will worry about why you do not want him/her to see you looking inside a patient's ear or checking their BP.

Checking the patient's understanding is one of the merit criteria for the assessment, but even if you are not chasing a merit, gaining marks here will give a positive impression and may help if your mark is borderline.

This criterion can be difficult to meet and it may appear patronising if you ask the patient to repeat what you have told them. Avoid asking every patient what they will tell their relatives when they go home.

Ask for feedback

Use your trainer to help you learn the skills and ask for their feedback on how you could do things better.

All too often, candidates try to persuade the trainer to help them decide whether a given consultation is good enough to include - unfortunately by then it is too late. Use your trainer as a teacher rather than a screening tool.

- Dr Mortimer is a GP trainer in Swansea, an MRCGP examiner and a teacher on the Swansea MRCGP course

LEARNING POINTS

Make sure your video reflects your level of skill

The aim of the video is for you to learn consulting skills which should allow you to discern what the patient is bothered about.

You need to develop your own techniques for generating enough trust for the patient to confide in you.

You are also required to give the patient the opportunity to be involved in significant management decisions.

Choose a range of different cases with a reasonable level of challenge.

Checking patient understanding is one of the merit criteria.

Ask your trainer to help you learn the skills and for feedback on how you could improve.

RESOURCES
www.rcgp.org.uk
www.londondeanery.ac.uk

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