'Real life' consultations could be kept under permanent changes to CSA exam

‘Real life’ consultations held by GP trainees in the recorded consultation assessment (RCA) could be retained as part of a permanent shakeup to the CSA exam, the RCGP has suggested.

RCGP vice chair of professional development Dr Michael Mulholland (Photo: Pete Hill)
RCGP vice chair of professional development Dr Michael Mulholland (Photo: Pete Hill)

Speaking at a session on the future of GP training and assessment during a two-day RCGP online conference last week, college vice chair of professional development Dr Michael Mulholland said that benefits of the RCA, including ‘real life’ consultations, could be maintained after the pandemic to improve assessments.

Dr Mullholland said that the RCA exam had helped to show what general practice was like in different parts of the country and should influence future changes to GP trainee exams after the pandemic.

He confirmed that the process to revise the CSA exam, which was paused back in May during the first wave of the pandemic, had already begun – and that the RCA would remain in place until ‘something better’ was introduced.

Recorded consultation assessment

Dr Mulholland said: ‘The RCA was put in as an emergency, temporary measure which was agreed with the GMC, but it fulfilled what was required. So it provided an exam that covered the curriculum and met the standards that it needed to have… The challenge we’ve had is, what do we do next?

‘We’ve had a lot of people saying there are elements of the RCA that are worth keeping; it is real life, it actually shows people where they practice and what it's like where they are. It also has things that we know are useful, people don’t have to travel to London, people don’t have to travel around the country.

‘What we are trying to do now is future-proof an exam that will both have the elements of real life practice – which is really important that people have a chance to practice where they are – and also have some possibly more standardised cases and complexities, so we know that everyone taking the exam across the country is taking something that is testing them.'

When asked about how long the RCA would remain in place Mr Mullholland said: ‘We don’t know that yet. It will be maintained and kept fit for purpose and when we have an exam that is fit to go into the future we will retire it.’

GP trainees

RCA candidates are required to provide 13 consultations from their real life, which can be a combination of audio, video or filmed face-to-face consultations.

In contrast, CSA exam patients are played by trained and calibrated role players, and cases are written and assessed by working GPs. GP trainees were expected to sit the CSA at the RCGP's headquarters in London.

Last year Health Education England suggested that GP training in future would have to adapt to reflect the 'new norm' of a greater number of remote consultations that are likely to continue after the pandemic.

However GPs have warned that the move towards a significant number of appointments being conducted remotely has limited opportunities for trainees to develop crucial skills, such as learning how to build relationships with patients and recognising non-verbal cues.

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