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A tutor's take on MRCGP membership and exams

Dr Nigel Giam looks at questions thrown up by proposed changes in the MRCGP and provides some answers

Dr Nigel Giam looks at questions thrown up by proposed changes in the MRCGP and provides some answers

The controversial new MRCGP single assessment for all GPs is due to go live in autumn 2007. However, confusion reigns on the ground for registrars over many aspects of the new exam ­ and what to do in the interim.

In a nutshell, two modes of assessment (summative assessment and the MRCGP) are being replaced by new MRCGP (nMRCGP) from autumn 2007. Last applications for the current MRCGP will be taken in February 2007 (with an extension till May 2008 to take and pass all modules). Summative assessment has been used to date to define a minimum level of competence for the exiting GP registrar. The MRCGP, on the other hand, has generally been regarded and validated as an exam of excellence. New MRCGP will allow for a single route of assessment and successful attainment will grant a certificate of completion of training (CCT) and membership of the RCGP.

Well for the F21 doctor facing the new proposed curriculum for specialist training in general practice, life may seem easier with a single route of assessment. There will be three parts to this.

This will take place throughout the three-year programme; video and/or external assessment may play a part; multi-source feedback from your trainer, colleagues and patients may also feature. The details are yet to be finalised.

This essentially replaces Paper 2 of the current MRCGP.

This will take the form of simulated surgeries, but will also look at your management and clinical skills by using objective structured clinical examinations (OSCEs). It has been proposed that there will be 12 stations. A purpose-built RCGP OSCE skills centre is in the process of being built.The story is slightly more complex than that and there are several issues in nMRCGP that need to be highlighted. Some of the questions I have been asked and some of the issues I feel need addressing by the RCGP and relevant decision making bodies are:

There seems recently to have been a huge uptake of the current MRCGP exam by registrars, and more recently senior house officers who are still currently on VTS schemes. Is this a knee-jerk reaction? The consensus and impression from the opinions I have gathered from trainees is that nMRCGP somehow lacks the lustre of the old-style exam. That it may represent a step up from summative assessment but a step down and a fall in the standard of MRCGP. I believe it is worth attempting the current MRCGP as the exam is challenging but equally rewarding.

My decision-making and problem-solving skills were thoroughly assessed, and rightly so. Critical appraisal is an invaluable skill and one I am glad I have had exposure to it through the current format.It is worth noting that nMRCGP and the current MRCGP are serving different purposes. nMRCGP is in essence a licensing exam.

At a time when we are facing a shortage of GPs, all trainees must be questioning just how tough this licensing exam will be. Will it be as challenging as the current MRCGP? Will it be as respected? There is no definitive answer but everyone will have a view on this matter and inevitably there will be implications after 2007 of having 'old' or 'new' MRCGP.

The information has not been well disseminated, although the RCGP finally sent out an information sheet to my trainees last week2.There is currently an online response form for feedback on the new curriculum ­ if you have time to read all 486 pages. My own feeling is the RCGP needs to adopt a more supportive role for prospective members and a more trainee-centred approach to the development of its new curriculum.By the latter I mean better dissemination of information to deaneries, trainers and trainees with a guarantee that feedback will be looked at, discussed and acted on.

From 2007, every new GP will be a member. But some trainees are unsure of the benefits of membership and the role the RCGP has to play. I value my membership. Through my local faculty I have had support in developing my educational needs and have been involved in mentoring other members. The RCGP will no doubt have an increasing responsibility in voicing and supporting its members and GPs in general. Those entering the profession need to be reassured that this support will be there.

I don't know the answer to that, but again a support structure needs to be defined by the RCGP and training bodies. This will need to be up and running by 2007 to accommodate the small proportion of GPs who do not attain the nMRCGP. At a time when trainers are faced with challenges of accommodating F2 doctors, there will be a need to support trainees at all levels independent of performance.

The RCGP has to my knowledge not yet published details of how trainees who are not on a VTS will be able to access nMRCGP. More established GPs have the option of taking the current-style MRCGP up until 2007, after which membership by assessment may be the only option. Further clarification is needed.

Nigel Giam is a GP in Southwark, south London, and an MRCGP course organiser, London faculties RCGP (South London, North and West London) ­ he is also RCGP liaison officer on the London Faculties GPVTS committee

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