From August 2007 all new entrants to programmes for specialist training in general practice will work towards the MRCGP (Membership of the Royal College of General Practitioners) examination. Passing the examination allows the candidate to apply for a certificate of completion of training (CCT). It also confers eligibility for membership of the college, on payment of annual subscriptions.
The answers to most questions about the new exam and dates of future sittings can be found on the RCGP website.
The examination consists of three elements.
The Applied Knowledge Test (AKT)
This is a machine marked paper lasting three hours, with multiple choice type questions. It is an electronic test, and is taken at Pearson VEU professional testing centres. These are located in many areas as they also administer the theory test for driving.
The breakdown of topics examined are approximately:
- Clinical medicine: 80%
- Critical appraisal: 10%
- Administrative issues: 10%
More information about this element is available here.
The Clinical Skills Assessment (CSA)
This examination is described as 'an assessment of a doctor's ability to integrate and apply clinical, professional, communication and practical skills appropriate for general practice' (RCGP).
The CSA consists of 13 consultations lasting 10 minutes, with simulated patients.
The CSA tests the following elements of the curriculum:
- Primary Care Management
- Problem Solving Skills
- Comprehensive Approach
- Person-Centred Care
- Attitudinal Aspects
- Clinical Practical Skills
More information on this element including some sample cases can be found here.
This is intended to combine learning with teaching and assessment. It incorporates several formative assessments, which are carried out throughout the training. The WpBA is linked to the ePortfolio, an electronic learning and assessment record, designed to help the trainee record reflections and learning, and progress of continuing professional development. The ePortfolio will provide the information for the reviews which take place at stages throughout the training and at the end.
The assessment tools incorporated are:
- Consultation Observation Tool (COT)
- Case-based Discussion (CbD)
- Multi-source Feedback (MSF)
- Patient Satisfaction Questionnaire (PSQ)
- Direct Observation of Procedural Skills (DOPS)
- Mini Clinical Evaluation Exercise (mini CEX)
- Clinical Supervisor's Report (CSR)
Full information on all these can be found on the RCGP website.
A paper explaining how to develop reflective skills and recording is available here.
The trainee has responsibility for arranging assessments with these tools, and for the ePortfolio. The clinical supervisor will normally be the person carrying out the assessments, with the educational supervisor taking an overview of training. The assessor must be of sufficient seniority: ST4 or above, including senior specialist and practice nurse practitioners. The arrangements for educational supervision will vary with each scheme. The educational supervisor should be constant for most of the training period.
There are a number of specific areas of development in addition to the competence areas of workplace based assessment which must be completed to be able to work in general practice post CCT. These include understanding out of hours, audit and child protection training; these topics will normally be evidenced through the learning log in the e portfolio and final ARCP panels will review trainees learning logs to ensure that they have been completed before signing off the work place based assessment and allowing the trainee to apply for a Certificate of Completion of Training.
The requirements are:
For Out of Hours, at least six hours per month in general practice must have been undertaken – for more details see the pages on Out of Hours.
Trainees must be able to demonstrate a full understanding of audit. The best way of demonstrating this is to have undertaken a full two cycle audit during training. This is good preparation for independent practice; for revalidation GPs are required to demonstrate involvement in an audit or similar quality improvement project every five years. Final ARCP panels check to make sure that there is evidence of understanding of the principles of audit in the learning log.
All GPs are required to have Child Protection training at Level 2 of the Inter Collegiate Safeguarding competence framework although the nature of every GPs role means that they work to Level 3. (The intercollegiate report Safeguarding Children and Young People 2010 can be accessed here. Final ARCP panels will also therefore check for evidence of attainment of Level 2 Safeguarding training in trainees learning logs. It is also good practice to upload any certificate of BLS, ILS or ALS training to your ePortfolio.