This part of the triangulated nMRCGP is not a specific one-dimensional exam. Workplace-based assessment (WPBA) is a closely monitored and documented evaluation of your progress as a GP trainee, over the entire three-year training period, looking at your performance in those areas of professional practice best tested in the workplace. This is achieved through an integrated package, including multiple assessment tools and a competence-based training record.
WPBA is considered an essential part of the nMRCGP for three reasons. It reconnects assessment with learning and teaching; makes assessment authentic to the situations in which doctors work; and assesses professional skills, such as team work, that are difficult to assess in other ways. The skills, knowledge and attitudes that you display throughout the three years of development will all contribute to the final 'sign off' procedure.
Assessment tools and the eportfolio
The tools used to collect evidence for WPBA go beyond those used in the old MRCGP, and are kept within the eportfolio, an online record of your whole three years of training. These are: CbD (case-based discussion), COT (clinical observation tool), mini-CEX (clinical evaluation exercise), DOPS (direct observation of procedural skills), MSF (multi-source feedback) and PSQ (patient satisfaction questionnaire).
It will be your responsibility to ensure the necessary components are completed on time and the educational log kept updated.
For MSF, you need to nominate colleagues to feed back on your professional behaviour and clinical skills. The process needs to be co-ordinated twice in ST1 and twice in ST3. In ST1 this is from clinical colleagues only, but in ST3 will include non-clinical staff.
A patient satisfaction questionnaire, similar to that in existence for GPs as part of the national quality and outcomes framework, needs to be filled out by 40 patients on one occasion in ST3.
Formal external assessment of consultations has been dropped and replaced with a COT. Consultation skills will be assessed using video or direct observation during general practice and assessed, based on the MRCGP consulting skills criteria, on at least 12 occasions in ST3. While posted in secondary care, you will instead undergo a mini-CEX. This will be formally recorded on at least six occasions in ST1 and a further six in ST2.
Case-based discussions will be recorded in all three years including at least 12 times over ST3, and are designed to assess professional judgment.
Finally, eight mandatory examination skills, such as cervical cytology, and nine optional minor surgical skills will be assessed through DOPS. This is based over the whole three years but can be achieved before the start of ST3.
Through these tools and naturally occurring evidence, you will need to demonstrate 12 competences.
Your trainer or educational superviser will assess your progress in each of the 12 competence areas in a six-monthly review, providing feedback on areas of strength as well as development needs. For each competence, you will be graded on a scale according to the standard expected by the end of ST3 as: insufficient evidence; needs further development; competent; or excellent. On completion of the final review, your trainer will make a recommendation to the deanery regarding your competence.
Dr Elfes is a GP trainer, MRCGP examiner and nMRCGP assessor in Swanage, Dorset.
THE 12 COMPETENCE AREAS FOR WPBA
- Communication and consultation skills.
- Practising holistically.
- Data gathering and interpretation.
- Making a diagnosis/making decisions.
- Clinical management.
- Managing medical complexity and promoting health.
- Primary care administration and information technology.
- Working with colleagues in teams.
- Community orientation.
- Maintaining performance in learning and teaching.
- Maintaining an ethical approach to practice.
- Fitness to practise.
How to prepare for WPBA
WPBA is a closely monitored and documented evaluation of your progress over time, looking at your performance in those areas of professional practice best tested in the workplace.
The skills, knowledge and attitudes you display and reflect upon over the entire three years of development all contribute to 'sign off' at the end of ST3.
Familiarise yourself with the objectives on the RCGP website.
Take responsibility from the beginning of ST1 to plan the tasks you need to accomplish in each clinical post you are working in.
Make use of your local deanery and course organisers.
Establish contact with your educational superviser.
nMRCGP: the CCT and new Membership Assessment. The Royal College of General Practitioners 2007: www.rcgp.org.uk/the_gp_journey/nmrcgp.aspx.