GP training - Further study for GP trainees

The start of GP training marks an important shift in a trainee's focus. Although in most cases one continues to work in hospital wards, the mind becomes focused on how clinical and non-clinical scenarios would apply to primary care.

It also heralds the MRCGP exams. However, new trainees seldom think about these at the start of their training as they concentrate on gaining the maximum amount of benefit from their hospital posts.

There are also extra qualifications which the keen trainee can aim to achieve, not only to complement the clinical experience they gain from their hospital posts but also to add to their CV.

Obstetrics and gynaecology
The diploma of the Royal College of Obstetricians and Gynaecologists (RCOG) is probably the diploma most frequently attempted by GP registrars.

The exam format has changed to no longer include an objective structured clinical examination (OSCE), and now involves two 90-minute exams. Paper one is a mixture of extended matching questions and single best answers and paper two consists of multiple choice questions (MCQs).

There is an abundance of preparatory material available. There are websites which have databases of practice questions for the exams, as well as a number of text books. Green- top guidelines, accessible through the RCOG's website, are also an invaluable resource for the exam.

Two months into an obstetrics and gynaecology rotation should give sufficient grounding to start preparing for the exam. The RCOG does not specify a training requirement to sit the exam as long as the doctor is registered with the GMC.

Paediatrics
During the paediatric rotation, one may consider taking the diploma in child health, offered by the Royal College of Paediatrics and Child Health (RCPCH).

This is a two-part exam consisting of a written exam followed by an OSCE. The written exam is the same as the first part of the membership (MRCPCH) exam and is taken along with paediatric trainees.

This exam is orientated more towards primary care and community paediatrics so questions about 'cri du chat syndrome' and 'VACTERL association' are seldom encountered.

Nonetheless it remains a challenging exam which requires a reasonable amount of studying and experience of paediatric medicine.

Having used an online resource to prepare for the exam, I felt I was slightly over prepared for the exam as these websites are primarily set up for the MRCPCH. As a result, my constant worrying over getting the Trisomy 13 of Patau syndrome mixed up with the chromosome 15q deletion of Angelman syndrome turned out to be totally unnecessary. However, knowledge of such rare syndromes can give one the opportunity to shine in the OSCE.

Extremely well structured, the OSCE is a good test of paediatric skills and knowledge at the primary care level. It has a range of stations testing communication skills, clinical examination skills, history taking, child development assessment and problem management.

New stations to be added soon are safe prescribing and data interpretation. The RCPCH recommends a minimum of six months' experience in paediatrics prior to sitting the exam but it is not a prerequisite.

Geriatric medicine
When I told colleagues I was going to attempt the diploma in geriatric medicine, I was met by some confused looks. I was struck by how few people had heard of this diploma offered by the Royal College of Physicians (RCP).

This feeling of amazement was reinforced when I sat down in one of the smaller rooms at the RCP among only 50 or so other candidates to take the written exam.

This is a two-and-a-half-hour exam with 60 MCQs covering a wide variety of issues ranging from epidemiology to ethical dilemmas in geriatric medicine.

A six-station OSCE tests clinical examination and history taking skills.

The diploma is taken mainly by GPs and old-age psychiatrists to show a competence in delivery of a higher standard of care to the elderly. Success in this diploma ensures exemption from a third of the modules and fees of the MsC in Gerontology course at King's College, London.

There is no specific guide for the exam but geriatric text books will help you prepare.

Other diplomas
Other diplomas include the diploma of the Faculty of Sexual and Reproduction Healthcare, which in its new format involves a combination of e-learning modules and direct observation of skills.

For GPs with an interest in offering minor ENT surgery in general practice, the diploma of otolaryngology - head and neck surgery is the gold standard.

The pressure on GPs to look after their patients in the community setting and to reduce referral rates to secondary care is undoubtedly increasing.

There is an increasing need for GPs to expand their skills base to be able to deal with the challenges that lay ahead and these diplomas are a satisfying way of doing so.

Visit the GP Curriculum Centre for hundreds of articles linked to key topics in the RCGP curriculum

Dr Razaq is a GP in Berkshire.