Summative Assessment - Evaluating a registrar'scompetency

Despite the workload, summative assessment is an enjoyable experience, writes Dr Alison Glenesk.

Summative assessment is an evaluation of competence in general practice. Despite the fact that summative assessment is going to be replaced with the MRCGP exam, registrars in post at present, and those starting in August, will still have to sit either summative assessment or both.

The audit

You should start the audit as soon as possible because you will have to perform an initial audit, effect change and then reaudit.

Discuss possible topics with your trainer. You may have an area of interest already, or might find it useful to look at the NICE or SIGN guidelines for inspiration. You might also find that one small area of GMS contract activity has been causing the practice difficulty, and that an audit and action plan will be of value.

Having chosen your area, and discussed your project with your colleagues, pick one or two criteria to look at. Many GP registrars choose either too many or too complex criteria, therefore keep it simple. You then have to set standards - give your criteria a numerical value. These may come from contract areas, or by consensus after discussion with the practice.

Next, choose your sample, do the audit and discuss the results. The next steps are to identify what changes would improve the outcome, implement that change and reaudit. It is important to discuss your finished work with your trainer, who will offer constructive criticism.

Make sure you have a description of how you carried out each step, show evidence of teamwork and have a discussion at the end.

Also make sure that the wording of your criteria and standards is identical throughout to avoid your audit being returned for resubmission.

The video

The video component can be a little labour-intensive. Start using the video camera early in your registrar year, but do not expect anything usable for a few months, by which time basic consultation skills should be second nature and you can concentrate on the finer points.

Assessment is done under three areas; namely 'listening', 'action' and 'understanding'. The first two involve taking a reasonable history and then doing something sensible with it, while the third looks at your interpretation of the process as detailed in your log diary, and your ability to look at the consequences of your consultation.

Pitfalls can include dangerous consultations or failing to appreciate that a patient is suicidal, prolonged and disorganised consulting, all consultations of low challenge, and failure to examine the patient.

The trainer's report

This is your trainer's assessment of your progress. Generally, your trainer will be assessing you continually, as well as doing some formal appraisal, and should give you adequate warning if you are likely to fall short in any area, so that you can take some remedial action.

The multiple choice paper

This is a three-hour paper covering all aspects of general practice, which takes place four times per year. The official line is that general reading and keeping up-to-date should be enough preparation.

Success in the MRCGP paper also counts for summative assessment.

There is a lot to get through for summative assessment, but the failure rate is very low, so there is no need to panic.

- Dr Glenesk is a GP in Aberdeen and a summative assessment examiner.


How to prepare for summative assessment

- Discuss your choice of audit with your trainer and start it as soon as possible, because you will have to perform an initial audit, effect change and then reaudit.

For the video component, start using the video camera early in your registrar year. But use early videos to learn, not as part of your submission.

Look over the trainer's report early to see what is expected of you and try to get the most of the practical skills observed during your introductory period.

For the multiple choice paper, general reading and keeping up-to-date should be enough preparation.


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