Abstract
Welcome to the new look Crammer’s Corner. Over the past year or so we have been exploring each of the clinical modules in turn, and discussing what they each encompass and how the ePortfolio can be used to show competence in that area. Moving forward with the column, we are going to change focus to the components of the Membership of the Royal College of General Practitioners (MRCGP). We will take each of the three areas in turn, Applied Knowledge Test (AKT), Clinical Skills Assessment (CSA) and Workplace-based Assessment (WPBA), provide an initial overview and then include articles from a wide range of authors, such as GP trainers, GP trainees, AKT question writers, CSA examiners and CSA actors. We hope to provide GP trainees with a comprehensive view of the MRCGP, from a wide range of perspectives, and we hope that you find the column useful and informative.
Overview of the Membership of the Royal College of General Practitioners (MRCGP)
MRCGP
It is now a mandatory requirement for all GP trainees to pass the MRCGP in order to be able to receive their certificate of completion of training (CCT) and practise as an independent practitioner in the UK. The MRCGP is awarded by the RCGP on completion of GP speciality training, providing that all three components, the AKT, CSA and WBPA assessment, have been successfully completed. The three components each use different assessment methods and tools to assess a specific area of the RCGP curriculum in a particular way and when combined to allow for a comprehensive standardised means of assessing competence in General Practice.
AKT
The AKT is a computerised test designed to assess the knowledge base required to be a GP. It consists of 200 questions, 80% of which are on clinical medicine, 10% on critical appraisal and evidence-based clinical practice and 10% on health informatics and administrative issues. Candidates are allowed 3 hours and 10 minutes to complete the assessment. The focus of the assessment is on applying knowledge to UK General Practice and problem solving rather than fact recall. The RCGP has compiled an ‘AKT Test Content Guide’, which GP trainees can access through the RCGP website, outlining all the subject areas that may be tested.
Preparation for the AKT may be as individuals or in a group, and may include practising questions online, using AKT revision books and aids, discussing clinical questions with other GPs, reading sections of the British National Formulary (BNF), attending a hot topics course and reading national clinical guidelines. It should be noted that the AKT is a fairly pressurised exam in terms of time and candidates must ensure they build up their stamina in answering lots of questions in a relevant time frame.
GP trainees are able to sit the AKT in their ST2 or ST3 year and have up to four attempts to pass. They should be aware that the clinical medicine questions relate to management in General Practice and therefore it is useful, although not mandatory, to have experience of working in primary care before sitting the AKT. The AKT is held three times a year at 150 Pearson VUE testing centres across the UK and is bookable via the RCGP website in a specific booking period. Results are uploaded directly onto the GP trainee’s ePortfolio 3–4 weeks after the exam and a breakdown is given on the performance in each of the three areas.
After each sitting of the AKT, a feedback report is put together providing statistical analysis of the results and highlighting areas in which trainees performed poorly. Reading previous reports can be helpful as part of a trainee’s AKT preparation.
Clinical Skills Assessment (CSA)
The CSA is an Objective Structured Clinical Examination (OSCE)-style assessment used to assess a GP trainee’s ability to integrate knowledge, clinical skills and communication skills into the GP consultation. Focus is on history taking and examination skills, management of common or important conditions in primary care, problem solving and data interpretation skills, and personal and professional conduct. The CSA is held several times a year (the timings of which are constantly evolving) at the RCGP headquarters in Euston, London. The format is a simulated surgery involving the GP trainee seeing 13 actor patients, in 10-minute slots, in their own ‘consulting room’. Details for each case are provided via an iPad in the consulting room. Each case in the CSA is marked by RCGP-approved examiners who enter and leave the consulting room with the actor. A mark is given for each of three domains: data gathering, clinical management and interpersonal skills. The marks for each of the 13 cases are added together to give a final mark. The pass marks are calculated and are specific to an individual cohort. Results are uploaded directly onto a GP trainee’s ePortfolio, usually around 2–3 weeks after the examination.
The CSA is undertaken in the ST3 year and candidates are allowed up to four attempts to pass. It is booked, on a first-come-first-served basis, via the RCGP website during the associated booking window for the date required.
CSA preparation is often done in groups of peers sitting the assessment at a similar time, with rotation of the roles of doctor, patient and examiner. Such revision groups can be extremely effective but do have their drawbacks and candidates must ensure that they are benefiting from the group that they are in. It is also important to remember that while in General Practice, every surgery is revision in itself.
Workplace-based Assessment (WBPA)
The WBPA is a tool that allows GP trainee’s to collate evidence via an ePortfolio, throughout their whole GP training programme, for the 13 areas of professional competence. A GP trainee is able to capture learning experiences and reflect on them to show progress towards achieving the competences, covering all the curriculum statements. A GP trainee is required to complete a mandatory number of assessments, which are also recorded on the ePortfolio: Case-based discussion (CBD), consultation observation tools (COT), multi-source feedback (MSF), patient satisfaction questionnaire (PSQ), clinical examination and procedural skills (CEPS), clinical evaluation exercise (Mini CEX – the hospital version of COTs). The personal development plan (PDP) section of the ePortfolio allows the GP trainee to set out learning objectives they hope to achieve throughout each part of their training.
The GP trainer at the practice where the trainee will go to complete their ST3 post in general practice acts as the trainee’s educational supervisor (ES) and is responsible for reading the ePortfolio while the trainee is in a hospital. In some deaneries, the ES during a ST1 or ST2 general practice post is the trainer at that practice. The ePortfolio allows the trainee and GP trainer to have this virtual dialogue with one another, which is extremely important as they may have little direct observation of each other’s learning and teaching styles and clinical strengths and weaknesses.
At the end of every review period (commonly 6 months in full-time training) the GP trainer is required to complete the educational supervisors’ report (ESR), which provides evidence for the Annual Review of Competence Progression (ARCP) panel as to whether the trainee has made satisfactory progress to continue or complete their GP training. Further evidence is provided via the clinical supervisor report (CSR) if the trainee is in a hospital post (as the GP trainer may not have had any experience of observing the trainee’s clinical performance during that time).
The MRCGP is always evolving; for the most up-to-date information please consult the RCGP website.
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The RCGP website has excellent up-to-date information with regards the MRCGP: