Look out for the new MRCGP exam

The MRCGP exam is changing. Dr Bill Irish explains the effects

The new MRCGP (nMRCGP) exam will be introduced as the sole route to licence as a GP in the UK from August 2007.

For current GP registrars, the last opportunity to apply for the existing MRCGP exam will be 2 February 2007. Any doctor wishing to apply to sit the exam after 3 February 2007 will be required to complete the nMRCGP.

The new exam will also replace the summative assessment. GP registrars who started training before 1 August 2007 who have not completed any summative assessment modules by 31 July 2007 will be required to complete the nMRCGP. Those who have passed at least one component of summative assessment can elect to either continue or switch to the nMRCGP.

It is anticipated that candidates will have to pay for the new exam, which is a change from the current situation where summative assessment is free. Three components will make up the nMRCGP: the applied knowledge test, the clinical skills assessment, and the workplace-based assessment.

The applied knowledge test
The applied knowledge test is a multiple-choice test of core clinical knowledge. This is really just an evolution of the current MRCGP multiple choice paper.

It is likely that this part of the exam will be taken directly on a computer terminal in a test centre local to candidates. This component will be offered three times a year.

The clinical skills assessment
The clinical skills assessment is a multiple station objective structured clinical examination. This will, at least initially, be run at a dedicated test centre in London.

It is planned that each candidate will rotate around 14-16 stations, mainly focusing on simulated consultations with patients. These will aim to test data gathering, technical and assessment skills; clinical management skills; interpersonal skills. This component will run more or less continuously from November to August of each year.

The workplace based assessment
The workplace based assessment is a significantly enhanced trainer's record where GP registrars are assessed by their trainer against predefined competences. 

Pass-fail decisions will be supported by a number of external workplace assessments such as video, patient satisfaction questionnaires and feedback.

National GP curriculum
The areas to be tested are defined by the new national GP curriculum. While the applied knowledge test - which is just an evolution of the existing MRCGP multiple choice paper - is almost completed,there is still significant development work still to be done on the clinical skills assessment and particularly the workplace-based assessment.

Assessors are now being trained to administer the clinical skills assessment, and pilots involving actual GP registrars will take place in the next few months.

For the workplace-based assessment there will be a significant challenge in establishing deanery infrastructures and preparing GP trainers.

Current MRCGP re-sits
The current arrangements that allow candidates to have up to three attempts at each of the modules of the existing MRCGP will be honoured.

In order, however, to avoid prolonging the period in which the old and new exams are running simultaneously, from May 2007 you will only have a maximum of 12 months to pass the exam.  After this it will be necessary to start again with the nMRCGP.

It is the intention of the college to allow multiple attempts for each of the nMRCGP's components, but details of this have yet to be determined.

The new format is not going to be any easier than the current exams. The RCGP, the Postgraduate Medical Education and Training Board and, in particular, the patient representatives contributing to the development of the new exam are all totally committed to maintaining high standards for those entering our profession. 

Those passing the nMRCGP will still need to demonstrate that their knowledge, behaviour and skills are at the highest level.

Dr Irish is a GP in Bath, and is associate director of GP Education Severn & Wessex Deanery, and MRCGP examiner

What the new MRCGP will mean for GP registrars

  1. The last opportunity to apply for the existing MRCGP exam will be 2 February 2007.
  2.  There will be opportunities to resit modules of the current MRCGP until May 2008.
  3. Taking the nMRCGP will be compulsory for all GP registrars starting their registrar year from February 2007.
  4. It will be necessary to pass the nMRCGP before practising as an independent GP.
  5. The nMRCGP will consist of three new modules - the applied knowledge test, the clinical skills assessment, and the workplace-based assessment.
  6. All of the new modules are currently under development, but there will be extensive guidance available for candidates before their introduction in autumn 2007.

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