MRCGP Video: Preparation for the video exam

Patient-centred consultations are key to the MRCGP video module, says Dr Bob Mortimer

The MRCGP video examination is designed to assess your competence in consulting skills. The video work book, which can be downloaded from the college website, describes the assessment in detail, including listing the performance criteria against which you will be assessed.

The video module was initially developed with Dr Peter Tate. Dr Tate is one of the four authors of The Consultation: an approach to teaching and learning, which is the source of what tends to be known now as Pendleton’s model of the consultation. This model focuses very much on patient centredness, gaining a clear understanding of the patient’s ideas, concerns and expectations. Patient-centred consulting is the key to success in this part of the MRCGP.

How to pass the exam
The video module is a little different in the way it is assessed — you need to pass each criterion to gain an overall pass. If you fail on an individual criterion you will fail overall and good performance in the other criteria will not compensate for this.

There are 14 criteria, of which 10 are mandatory, the remainder being the merit criteria. Each of your seven consultations will be watched by a different examiner who will make a decision for each of the 14 criteria. You will pass overall if you demonstrate competence in each mandatory criterion in at least four of the consultations.

Note that the criteria are outcome based and do not specify how you should achieve them. It is up to you to choose how you get there; this will depend on many factors including the nature of the patient’s problem, how articulate and confident the patient is and your own preferred consulting style.

Understanding the criteria
There are some drawbacks to focusing on each criterion in isolation. It is easy to miss the point of what you are trying to do overall and can lead to consultations that look and feel disjointed and wooden. It is better to consider the five broader areas under which the criteria are grouped, as described in the work book: discover the reason for the patient’s attendance; define the clinical problem; explain the problem to the patient; address the patient’s problem and make effective use of the consultation.

The first seems obvious, but remind yourself of the communication techniques that are likely to get as much out of the patient as possible — open questions, lack of interruption and relaxed body language. Make sure you find out how the problem is affecting the patient socially/psychologically. It is no good just finding out what he or she does for a living, you must find out how the problem affects them. You will need to be sensitive to what the patient thinks is going on and practice a few different techniques for finding out.

For the second make sure you do not concentrate on communication skills and forget about the clinical skills of taking a clear history and carrying out an appropriate examination.

Explaining the problem requires use of clear language and it must be tailored to the individual patient, making sure you take into account the health beliefs you discovered earlier.

For the fourth area, make sure you consider (and discuss with the patient) a sensible range of options.

Ensure you can be confident that the patient understands enough about your management plan to make an informed decision. Directly asking the patient to explain everything back to you does not work well, so ask if everything is clear to them, and if there is anything they would like you to go over again.
 
Close the consultation with clear advice about when they should come back.

Common pitfalls
Although there are lots of things that can go wrong with video consultations, there are a few recurring themes. Be selective with your consultations; a series of low-challenge or follow-up consultations will not allow you to demonstrate your skills to the required standard.

Make sure you gather enough information from the history and examination to make a diagnosis, but do not waste time with unfocused consulting.

Try not to dominate the consultation too much, and try to avoid thinking of involving the patient in management decisions as a simplistic presentation of options; find out their preferences and discuss them. Do not offer inappropriate treatments.

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