The aim of the MRCGP written paper is to test how well you can apply your knowledge. The first step in preparing for the exam should be to spend some time looking through the material provided on the RCGP website.
The exam regulations give lots of information on the major themes of the paper, with an extensive list of the skills and attributes it is designed to test. Copies of past papers are provided, with comments from the examiners for each question, detailing how well or badly candidates answered each question with information on what the examiners were looking for.
The duration of the paper is three and a half hours, and for some years now there have been 12 questions. This allows you 15 minutes to answer each question, with 10 minutes to read the material accompanying each of the three critical reading questions.
There are three main question types: questions that expect you to discuss a problem; questions that test your understanding of the evidence base for general practice and questions that test your critical appraisal skills. In recent years there have been seven problem-solving questions, two evidence-based questions and three critical appraisal questions.
The problem-solving questions can cover patients presenting with clinical problems, issues arising within the organisation of general practice and issues involving relationships with colleagues. Try to imagine yourself in the scenario — what would you actually do if you were in that situation? How would you feel? How do you think the patient or colleague would feel, and what would they be thinking? It is important to detail your reasoning and provide justification.
Try to be systematic and apply a logical approach — describe what information you’d gather, on history, examination and investigations. Consider a diagnosis then describe your management options and their implications. Think of the implications for not just the patient, but also their family and your colleagues both within the practice and in secondary care.
Also consider the wider options for the NHS and society maybe in terms of resources. Could you realistically solve the problem in a single consultation? If not how would you deal with it? If a problem might make you feel upset, stressed or angry how would you deal with that?
For many of these questions a passing grade can be gained by describing best practice without any specific references. Appropriately mentioning references will of course boost your score.
The more important chronic diseases such as hypertension, diabetes and heart failure tend to occur frequently. Screening is a commonly recurring theme: you can score marks by considering generic issues relating to screening without knowing much about the specific issue itself.
The critical appraisal questions have followed a pattern over recent years. There have been three in each paper, two of which have been based on a single paper, with the other based on either a research paper or occasionally a practice audit or drug company marketing material.
The paired questions have followed a consistent pattern in that the first refers to the methodology of the paper, the second to the results section.
Again, some generic approaches can be used – the methodology question generally includes describing how you would gather evidence. The results question generally asks you to consider the implications of the paper on general practice.
On the day
It is important to write efficiently. Do not write long sentences and flowing prose, use headings, bullet points and short notes, and make sure you write legibly. Spend a couple of minutes organising your answer and brainstorming the issues you want to discuss.
Time management is critical, and even if you feel you are doing well on a question don’t spend more than 15 minutes on it. Inevitably there will be one or two questions that take you less time and you can go back to questions later.
Do not be put off by what appears to be a difficult question, because no matter how blank your mind initially goes it is highly unlikely the examiners will have set a question you really cannot write something sensible about.
Dr Mortimer is a GP trainer in Swansea, an MRCGP examiner and a teacher on the Swansea MRCGP course
Practice makes perfect if you want to succeed
- Practise answering the past papers provided on the College website.
- Practise your problem-solving skills in everyday surgeries.
- Work with friends to predict and research hot topics.
- Rehearse some generic answers for the critical appraisal questions.
- Practise organising answers and writing in note form.