The MRCGP

The MRCGP is an assessment system which confirms whether or not a doctor has successfully completed General Practice training to a satisfactory standard for independent practice in the United Kingdom. Doctors cannot earn their CCT in General Practice, nor become full Members of the RCGP without doing so.

Structure of the MRCGP

The MRCGP comprises three separate examinations, namely the

• AKT, or Applied Knowledge Test;
• CSA, or Clinical Skills Assessment; and
• WPBA, or Workplace-Based Assessment.

Each of the above examinations assess different competences by using validated assessment methods covering the entire oeuvre of knowledge, behaviours, and aptitudes as per the GP Speciality Training Programme’s curriculum. The MRCGP also meets the best practice guidelines as set out by the GMC with regards to standards and quality assurance.

The Applied Knowledge Test

The AKT broadly assesses the knowledge that underpins independent General Practice in the UK. In order to pass, doctors should demonstrate competent application of their clinical skills.

The candidate will take the AKT as a computer-based three-hour and ten-minute examination, comprising 200 questions, and delivered thrice yearly at 150 Pearson VUE centres. 10% of the questions will be on critical appraisal and evidence-based clinical practice, and an additional 10% on health informatics and administration. The remaining 80%, therefore, will examine clinical medical knowledge – often requiring high-order problem solving.

AKT Dates

The Clinical Skills Assessment

The CSA is a broad assessment of a doctor’s ability to consolidate communication and practical skills with a professional clinical approach. The CSA simulates a typical NHS clinic, and then uses this setting to test a wide range of skills drawn from the curriculum.

The overall aim of the Clinical Skills Assessment is to establish the level of a doctor’s aptitude, with specific focus on how well they glean information and then apply their understanding of disease and care in an appropriate way. They should male evidence-based decisions and show competence when communicating with patients and fellow NHS staff.

The CSA uses the OSCE format to simulate consultations, with patients played by actors, and cases written by practising GPs. Each candidate will have 13 stations to complete, and 10 minutes in each station.

The Consultations

The CSA consultations test competences mapped to the General Practice curriculum, and test each of the following specific areas:

• Primary Care Management, during which candidates should recognise common and important medical conditions in a primary care setting, and manage them appropriately;
• Problem-Solving Skills, during which candidates should demonstrate the ability to gather and use data for clinical judgement, investigations, and choosing which examination to proceed with – they should also prove that they can interpret data, and demonstrate a structured a flexible approach to decision-making;
• Comprehensive Approach, during which a candidate should demonstrate proficient skills in managing co-morbidity and the associated risks;
• Person-Centred Care, during which candidates should communicate with patients using recognised consultation techniques, in order to promote a shared approach to health management;
• Attitudinal Aspects, during which candidates should practice ethically with respect for diversity and equality; and
• Clinical Practical Skills, during which candidates should demonstrate proficient physical examinations, with particular focus on their skills with diagnostic and therapeutic instruments.

Use of Minors

Children have been used in the CSA since it was first implemented. Candidates are therefore highly likely to encounter a paediatric case in their examination. Children working in the CSA will also be accompanied by a parent, who will be the primary contact for the candidate. Even if a paediatric case is included, which has been the case since November 2013, a child may not actually be present in the examination room.

CSA Dates

The Workplace-Based Assessment

The Workplace-Based Assessment evaluates the candidate’s progress with regards to professional practice, and the markers of this that are best-tested in the workplace. The WPBA also takes place multiple times throughout GP Speciality Training. Additionally, the Workplace-Based Assessment

• provides an opportunity to gather evidence and reflect on performance,
• evaluates aspects of a doctor’s professional conduct that cannot be adequately tested in a traditional examination,
• gives constructive feedback to candidates,
• helps a candidate’s learning in important competence areas,
• assesses whether or not a candidate is fit to progress in their training.

WPBA Format and Candidate Review

Throughout GP training, candidates will record their competence achievements in their Trainee ePortfolio. These evidences will relate to 13 separate areas, and are used as the basis for biannual reviews, as well as the final judgement on whether or not a candidate is prepared to begin practising independently. At each review, candidates should provide evidence that is evenly spread across the competences. Different tools make up the WPBA, and are as follows:

• Case-Based Discussions, or CbDs;
• Consultation Observation Tools, or COTs, in primary care only;
• Multi-Source Feedback, or MSF;
• Patient Satisfaction Questionnaires, or PSQs, in primary care only;
• Clinical Examination and Procedural Skills assessments, or CEPS;
• MiniCEXes, or Clinical Evaluation Exercises, in hospital posts only;
• Clinical Supervisor Reports, or CSRs, in all hospital posts, and primary care;
• The Learning Log;
• The Personal Development Plan, of PDP; and
• Direct Observations of Procedural Skills, or DOPSes – in circulation until November 2015, but still accessible in the ePortfolio, and now a contributing factor in the CEPS.

More information on the individual tools is available here.