Be ready for the MRCGP exams

In the latest extract from The Condensed Curriculum Guide, Dr Ben Riley and Dr Jayne Haynes discuss how to succeed at the new MRCGP.

The new MRCGP is designed to assess the behaviours a GP performs in the workplace. These behaviours are based directly on the six domains of competence and the three essential application features described in the RCGP curriculum. The nMRCGP has three components: the applied knowledge test (AKT), the clinical skills assessment (CSA) and the workplace-based assessment (WPBA).

The applied knowledge test
The AKT is a multiple-choice question paper with around 200 questions, to be completed in three hours. It tests both clinical and non-clinical aspects of general practice knowledge and assesses the application of knowledge. About 80 per cent of the questions will be on clinical medicine, 10 per cent on admin and health informatics, and 10 per cent on research, critical appraisal and evidence-based medicine.

One of the best ways of preparing for the AKT is by ensuring you have a broad working knowledge of general practice. The Condensed Curriculum Guide summarises the core knowledge and skills from each of the curriculum statements, providing a useful checklist for covering the key areas.

The clinical skills assessment
The CSA is an objective structured clinical examination (OSCE)-style examination with 13 scenarios, each lasting 10 minutes, and tests clinical, communication and practical skills. It involves simulated consultations with specially trained actors playing the role of patients. Candidates undertake a mock 'surgery' and remain at their station while the simulated patients and examiners rotate around them.

The purpose of the CSA is to assess a doctor's ability to apply their clinical, professional, communication and practical skills to a standard appropriate for general practice. One of the key functions of the CSA is to identify potentially dangerous GPs.

Stations that could come up include: communicating sensitively with a depressed patient (played by an actor) and assessing their suicide risk; checking and demonstrating the inhaler technique of a patient with asthma; and performing a pelvic examination on a mannequin.

The workplace-based assessment
The WPBA assesses aspects of professional behaviour that cannot be tested reliably in an exam situation (such as team work).

Specialty registrars and trainers can collect all the evidence they need to complete the assessment in an 'eportfolio', specially developed by the RCGP. The eportfolio also stores the training record, which contains: the record of learning, including tutorials, group learning sessions and seminars attended; the technical skills log, including examinations and procedures performed; and the evidence of professional competence, which contains regular staging reviews.

GP trainees meet with their trainer or educational supervisor to complete an interim review, looking at progress towards the 12 competency areas of WPBA, each six months.

A test of competence
The curriculum and nMRCGP both emphasise the importance of developing professional competence. In the next article, we will explore the six core competences of general practice in more detail, and reveal some practical ways to learn them.

- Dr Riley is a GP in Oxfordshire and RCGP curriculum development fellow and Dr Haynes is also a GP in Oxfordshire Learning points

How to succeed at the new MRCGP

  • One of the best forms of preparation for the applied knowledge test is to develop a broad working knowledge of general practice.
  • The clinical skills assessment tests clinical, communication and practical skills in an OSCE-style examination.
  • To prepare for the clinical skills assessment, video and analyse your consultations and sit in on other GPs' consultations.
  • Ask for feedback from colleagues and patients.
  • To prepare for the workplace-based assessment, monitor your progress against the 12 professional competences.

SOME TIPS FOR PREPARING FOR THE CSA
  • Consultation analysis: Video lots of consultations and use a variety of methods to analyse them.
  • Joint surgeries: Sit in or watch a video of a range of GPs' and practice nurses' consultations. What do they do well? What could they do better?
  • Learning groups: Learning groups are good preparation for the 'softer' GP topics, including ethical and professional dilemmas.
  • Log of procedures: Make sure you are competent in all the psychomotor skills required: a summary can be found in The Condensed Curriculum Guide.
  • Role-play: Role-play is one of those things nobody really likes but everyone has to do. Always bear in mind the rules of giving effective feedback.
  • 360 degs feedback: Encourage colleagues to feedback on your management of patients - particularly when they see a patient you found challenging. Obtain feedback from patients using tools such as the patient satisfaction questionnaire.

Resources

  • The Condensed Curriculum Guide, RCGP 2007 by Dr Ben Riley, Dr Jayne Haynes and Professor Steve Field
  • The Condensed Curriculum Guide is the official guidebook to the RCGP curriculum.
  • It is available from the RCGP Bookshop. Online: www.rcgp.org.uk/acatalog; phone: (020) 7581 3232; fax: (020) 7581 8154. RCGP members and associates receive a 10 per cent discount when ordering this book.

- The GP Journey section of the RCGP website contains detailed information on the nMRCGP and eportfolio.

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