The first to face the nMRCGP

Dr Anna Cumisky was in the first cohort of doctors to use the RCGP curriculum and pass the nMRCGP.

Q: How did it feel to be one of the first to work with the new RCGP curriculum?
In some respects, being the first group on a new scheme is quite exciting although more frequently, unfortunately, the feeling was of being a guinea pig. I was fortunate in that my trainer is very active in trying to keep abreast of changes, but even she struggled at first.

The new curriculum document itself seems quite comprehensive and the abridged version is quite easy to flick through. It is extremely useful when it comes to planning tutorials and also when revising for the exams. An almost pleasant read.

Dr Anna Cumisky worked well with her trainers and found her training practice supportive of her needs

Q: Was it a positive experience compared with what you knew about the previous scheme?
Yes and no. The old scheme seemed to work well enough and I heard only good reports from it. The only downside to it seemed to be time spent on ensuring the videos covered all areas.

The new scheme uses videos simply as an in-house learning tool and relies on the clinical skills assessment (CSA) to review 'actual practice'. This is a good thing that both trainers and trainees seem to prefer.

nMRCGP aims for standardisation in many areas, potentially running a risk of producing GP clones. However, the new scheme should help to ensure fewer of the underperformers struggle through. The downside is that the distinction/merit brackets have gone and, with them, the chance to achieve excellence.

Q: How did you find using the ePortfolio?
There were pros and cons. The pros were that it helped standardise entries and helped to direct the thinking and learning process. It was much easier to communicate with the deanery or RCGP than having to send hard copies.

Another advantage is that all of the 'coursework' is in one place rather than sending separate videos, audits and so on.

Also, given the future role of appraisal and revalidation in general practice, the ePortfolio is a useful tool to get doctors used to working in this way. In time, it would be ideal if the ePortfolio could continue on as an appraisal tool.

It is definitely not perfect, though. The self-directed learning log entries forced every small item to be thought about in so many ways that it became highly tedious - what have I learnt, what did I hope to learn, did I learn what I hoped to learn, what ongoing learning needs have been brought to light, when do I think I will cover these ... add nauseam.

The major problem was that so few people seemed to have had any decent training in the ePortfolio prior to its launch that the inevitable teething problems remained unanswerable. Access was very delayed so we had only eight months in which to record adequate entries to cover the year.

There was no guidance on how many entries were expected and initially the trainer and trainee were unaware that each other's pages were very different in appearance and function.

That said, the help desk were excellent and attended to our issues quickly.

My understanding is that, one year on, the ePorfolio comes with better guidance and, obviously, people have better knowledge of how to use it. Some of its early pitfalls were probably inevitable but overall I don't think it's that bad.

Q: Did you feel the assessments matched the reality of daily practice?
The CSA certainly lived up to its reputation as 'the surgery from hell'. It would be unlikely to ever face quite so many tricky cases in one session. However, it is a useful tool and certainly assesses a doctor in action and under duress.

The applied knowledge test was useful early on in the year to ensure a good knowledge base.

The ePortfolio and workplace-based assessments were probably the most appropriate areas. I think video analysis is one of the best tools. Now videos are only used in-house they are likely to be more 'real' and, as a result, extremely useful when trying to analyse personal practice. Having them reviewed by different doctors is best.

Q: Do you think your experience of the curriculum was typical?
For the most part, yes. I had a brilliant trainer, who I loved working with and this certainly helped. My practice was also very aware that I was there to train and accommodated my needs as best they could. In return I was happy to help out when needed.

A numbers of my colleagues seemed to have a similarly good experience, but sadly not all.

Q: Is there any advice you would give future registrars?
Read lots and ask questions - of your trainer, educational supervisors and other registrars. To avoid missing out on things one needs to keep active. Hospital life is rather spoon-fed but the registrar year is self-directed.

  • This topic falls under section 3.7 of the GP curriculum 'Teaching, Mentoring and Clinical Supervision',

Dr Cumisky's recommended resources

  • RCGP website:
  • Medical newspapers are excellent for keeping abreast of recent changes.
  • Your deanery website.
  • Induction pack issued by your deanery.
  • Oxford Handbook of General Practice - a lifesaver!

Dr Cumisky is a locum GP in Bath.

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