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In the first of a series of articles to help readers pass summative assessment and the MRCGP, Dr Mei Ling Denney describes the current system, and highlights impending changes

General practice is undergoing considerable change at present, and that includes registrar training and assessment.

From August 2007 there will be a single new assessment process called 'nMRCGP'. Not only does this mean membership of the RCGP, it will also be an essential requirement for entry to the GMC Generalist Register. We are now in a transition period that runs between 2005 and 2008, so the situation is somewhat complex for those doctors currently in general practice training.

Current summative assessment and the MRCGP

The four elements of summative assessment are:

• a multiple choice question paper, testing knowledge

• a video, testing clinical and consulting skills

• a written submission of practical work – either an audit or project

• the structured trainer's report (STR).

Success in the MRCGP exam confers entry to the RCGP. The exam is modular, and each of the four modules must be passed:

• a multiple choice question paper with 'single best answer' and 'extended

matching' questions

• a written paper, containing critical

reading questions and modified essay


• a consulting skills component, usually a video, sometimes a simulated surgery

• an oral exam.

A pass in the MRCGP MCQ paper exempts you from the summative assessment MCQ, and a pass in the MRCGP video module exempts you from the summative assessment consulting skills component.

More details can be found on the summative assessment website or the RCGP website

The future: nMRCGP

In just over a year, summative assessment and the current MRCGP exam will be replaced by the nMRCGP. This will become the end-point exam in vocational training for doctors wishing to obtain a certificate of completion of training (CCT) in general practice. The elements of the nMRCGP will be:

• a multiple choice paper, the applied knowledge test (AKT)

• a clinical and consulting skills test, the clinical skills assessment (CSA)

• workplace-based assessment (WPBA), which will include an enhanced trainer's

report (ETR)

The AKT will be similar to the current

MRCGP MCQ, testing application of knowledge. It is likely that there will be a little more emphasis on clinical aspects than


The CSA will be held in an assessment centre, probably consisting of 14 stations, testing candidates on realistic general practice situations enacted by simulated patients.

The enhanced trainer's report of WPBA differs from the current structured trainer's report in that it is a competence-based workbook. Registrars should already be familiar with competence-based assessment, as this is the basis of the out-of-hours workbook, although the format looks different.

Work is still in progress on the new assessments, and the final guidance on all of these will be released at a later date, as it is still subject to approval by the Postgraduate Medical Education and Training Board (PMETB).

If your VTS training began before August 2007, and you complete at least one component of summative assessment by July 31 2007, you have until July 31 2008 to complete the summative assessment modules. If you have not completed any summative assessment modules by the end of July 2007 or because you have taken leave from your VTS, it is unlikely that you will complete training before July 31 2008 and you are advised to pursue the nMRCGP assessment.

The transition arrangements for summative assessment are complex, and registrars should read Specialist Training for General Practice Information Sheet No 3, available on the RCGP website.

Mei Ling Denney is a GP in Peterborough who examines for summative assessment and the MRCGP, and is involved in nMRCGP

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