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 VUE 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 is the pre-covid 19 version of the RCA and 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.
The Recorded Consultations Assessment (RCA)
The RCA is a summative assessment of a doctor's ability to integrate and apply clinical, professional, communication and practical skills appropriate for general practice. It uses pre-recorded video or audio consultations to provides evidence from a range of encounters in general practice relevant to most parts of the curriculum and also provides an opportunity to target particular aspects of clinical care and expertise (RCGP)
Format of the RCA:
- The RCA will provide an objective assessment of clinical skills from real life settings provided across 13 consultations and undertaken by the candidate from their own current working environment. Due to the response to the pandemic situation it is likely that the majority of these will be conducted remotely.
- The RCA will be sat during the ST3 year or beyond of training and recordings will be made during this time.
- They may be any combination of audio, video or face to face consultations.
- Cases will be submitted to a central facility - the FourteenFish RCA Platform.
- Cases submitted should be of an appropriate level of challenge for an ST3 trainee to demonstrate safe and independent practice.
- These cases will be assessed by trained and calibrated examiners who are experienced GPs.
- Each consultation will be viewed independently by at least one examiner who will make a global judgement of that consultation, attributing marks in three domains and blind to other marks the candidate receives for that or any other consultation.
- It is the responsibility of the candidate to obtain consent from the patient under the usual guidance for training and GDPR. This may be on the FourteenFish RCA Platform directly where this is used to record the consultation, in written form kept by the practice (paper/electronic) or verbally (on camera, the timing of which will not be counted as part of the ten minutes to be assessed or off camera, but a record kept).
- Recordings submitted for the RCA will be deleted from the central IT platform after the Examination Board has ratified and published results. Material uploaded to the central IT platform but not submitted for the RCA will be deleted after 26 weeks (182 days). In exceptional cases, the Examination Board may approve retention for a longer period, the duration of which will be governed by GDPR principles.
- Recordings of individual consultations must be continuous.
- The camera should not be turned off during consultations and recordings must NOT be edited in anyway.
More information on this element including some sample cases can be found here.
The Workplace Based Assessment (WpBA)
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:
- Case Based Discussion (CbD)
- Care Assessment Tool (CAT)
- Mini Clinical Evaluation Exercise (MiniCEX)
- Consultation Observation Tool (COT)
- The Audio-COT (Audio-COT)
- Clinical Examination and Procedural Skills (CEPS)
- Multi-Source Feedback (MSF)
- Patient Satisfaction Questionnaire (PSQ)
- Leadership activity and MSF
- Quality Improvement Project (QIP)
- Quality Improvement Activity (QIA)
- Prescribing Assessment
- Clinical Supervisors Report (CSR)
- Interim Educational Supervisors Review (Interim ESR)
Full information on the assessment tools, as well as other resources can be found on the RCGP website.
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:
One of the requirements during GP training is to demonstrate your capabilities in Urgent and Unscheduled care. This includes delivering safe patient care, demonstrating effective communication skills, maintaining continuity for patients and colleagues, coordinating across services and enabling patient self efficacy.
The requirements for urgent and unscheduled care, which includes out of hours have recently changed and the attached document will explain in more detail what is required in order for you to demonstrate your capabilities within this curriculum area.
For more details see the RCGP 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.