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CAMHS won't see you now

GP demands Piano Man plays it again

I believe new GPs will welcome the new format of the MRCGP. Although the exam to date has been well-validated as a specialist exam, its modular nature coupled with the pressure of trying to complete all four modules within the span of the GP registrar year can at times prove a little too onerous.

There is a need to make membership to the college more 'accessible' and by removing the current two-tier assessment ­ that of summative assessment and the MRCGP ­ this will help to bring consistency to both the assessment and learning experience of new GPs.

I am anxious though at the potential implications of failing the MRCGP if this is to become the exit exam to the registrar year and the entrance exam to the profession. The MRCGP currently has about a 75 per cent pass rate. What will happen to the 25 per cent of new GPs who do not make the grade?

Will they continue in training posts till they attain the exam and who will continue to train them? We are already facing a shortage of training posts and capacity will be further challenged through accommodating foundation SHOs. The RCGP needs to recognise that support structures have to be in place for candidates who fail and for the trainers who have to accommodate this.

In addition, I am interested in how the RCGP will endeavour to make membership accessible to doctors not on a VTS scheme or from overseas.

A move to objective structured clinical examination-based (OSCE) assessment seems probable and sensible and this would be in keeping with other college membership exams. As OSCEs are now the mainstay of medical student assessment, this again should not be unfamilar territory for new GPs. This change has to be reflected in up-to-date RCGP courses, trainers and educational material .

In my opinion the change to a 'single' route for assessment and membership is welcome. I hope the change in the nature of the exam will make it more user-friendly and, more importantly, an exam that has clinical and practical relevance to everyday practice.

I believe that if the RCGP, current members and those involved in education can aspire to promote quality of care and clinical excellence through the MRCGP, the exam will be seen as a qualification to strive for.

Dr Nigel Giam

MRCGP Course Organiser

South London Faculty RCGP

·College membership is a long overdue entry requirement for general practice. No surgeon or physician would be considered for independent NHS practice without membership of their college.

The MRCGP exam is a well-tested instrument and is very much in touch with the world of general practice.

I welcome this proposal.

Dr Henry Smithson

North Yorkshire

·For years general practice has been the envy of other specialties because of the division between the RCGP and the JCPTGP. Other doctors have suffered from the effects of their college holding the monopoly control over entry into their specialty.

I remember at one BMA meeting a senior well-respected physician rather tongue in cheek suggesting that the colleges should remain in control of entry so they could to keep their wine cellars well stocked.

It has been considered for a long time that colleges run their professional examinations for two reasons ­ to make money and to allow 'the right kind of doctor' into their specialty. Even though most colleges have worked hard to try to make their professional examinations more relevant, I do not believe they have fully succeeded.

The advantage of the JCPTGP was that summative assessment was not developed only by the college, but in conjunction with the other stakeholders, including the GPC. This allowed the assessment to be more relevant to assuring the quality of new GPs.

I was a member of the JCPTGP at the time when summative assessment was implemented, and the view of some of the college representatives was that the MRCGP should be imposed as the only examination, despite the fact that at the same time the college was advocating that the MRCGP represented excellence in general practice rather than competence.

Your story (News, August 20) already raises the issue about the increased costs of training in general practice in the future. This will not only include any additional costs that the RCGP will levy as monopoly supplier of the examination, but the increased fees that will be charged by PMETB. The increased fees will particularly affect overseas doctors, or those applying for equivalent experience.

At a time of poor recruitment this can only be seen as extreme shortsightedness.

Dr Grant Ingrams

Coventry

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