The MRCGP oral exam focuses on decision-making skills rather than factual knowledge, says Dr Bill Irish.
Decision making, a key skill for a successful GP, is the main attribute that examiners try to assess in oral examinations.
As GPs we make hundreds of important decisions every day: is this slightly raised ALP significant? Does this febrile child have meningitis? What shall I do about a woman who refuses to have a cervical smear?
Thinking through a problem
The idea behind an oral exam for the candidates is to work through a series of challenging GP-based situations, and to assess how they appraise the problem, work out a range of options, consider the advantages and disadvantages of each, and finally make a decision - preferably on a basis of rational and consistent reasoning.
If you can demonstrate the evidence base that underpins your thought processes, you will be heading for a distinction.
Oral exams are not particularly good at assessing factual knowledge, which is better explored in written papers. Do not spend a lot of time revising lipid metabolism and porphyria and instead focus on more useful preparation, such as reading about key issues.
To test decision-making skills the examiner will present you with a challenging problem in an unfamiliar context. You should be able to work it out from first principles.
You will normally be asked questions in three different key areas: communication skills, such as breaking bad news, dealing with somatising patients and checking patient understanding; ethical reasoning, including end-of-life issues, rationing and confidentiality; and aspects of self-awareness, such as avoiding burn-out and having a balanced work-home life.
The most useful preparation you can do is to practise answering these types of questions. Make use of your trainer, course organiser, colleagues or local examiner to set you example questions. Other GP registrars often make useful 'examiners'.
Ask your examiners for feedback on how you could have done better and also consider how you could have structured your answers better.
Take time to read up on the key subject areas - communication, ethical reasoning and self-awareness. You need to be familiar not only with the basics of communication theory, but with the application of the theory in real life.
Reading about ethics and the various GMC guidelines are helpful, but concentrate more on thinking about how they actually help you solve difficult GP-based problems. Self-awareness is difficult to prepare for, but include research issues such as lifelong learning, revalidation, burn-out and cultural problems.
On the day of the exam, arrive about 20 minutes early. Dress appropriately, as if you were going for an interview. Take a few seconds to compose yourself in the first question. Sit close to the table and ask the examiners to repeat a question if necessary.
Bear in mind that the examiners are testing decision-making. Describe the problem, link it to an ethical or communication model (if appropriate), propose several options, choose one of them and then justify yourself. Do not come up with a snap decision and then spend the next three minutes trying to defend it.
If you become stuck on a communication question, using consultation models such as a framework will help you provide a reasonably structured answer. If you find yourself falling into complicated ethical areas, answering in the third person can sometimes help.
Follow the examiner's body language. If you are holding forth on ethics and her marking schedule is on communication skills, she will need to stop and redirect you.
Do not try to read your marks upside down. You will always get it wrong and this can have disastrous consequences.
Finally, try to enjoy the challenge. The exam is actually good fun once you get past the first couple of questions.
- Dr Irish is a GP in Bath, examiner for the MRCGP and associate director of GP education, Severn and Wessex Deanery.
Be aware of what examiners expect from oral exams
1. The oral examinations aim to assess decision-making skills.
2. During the exam you will be presented with a challenging problem in an unfamiliar context.
3. You will be asked questions on communication skills, ethical reasoning and self-awareness.
4. The most useful preparation you can do is to practise a lot with your trainer and colleagues.
5. Reading about ethics and the various GMC guidelines will help.
6. Be familiar not only with the basics of communication, but also with the application of the theory in real life.