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Independents' Day

GP trainer goes


to school

Becoming a GP trainer made

Dr Karen O'Reilly realise her own clinical and consultation skills were rusty. Her solution ­ to re-sit the MRCGP alongside her registrars

MRCGP: Why not do it again? Well maybe you're not as crazy as I am. You have better things to do with your time. Whichever, the fact is that I, an experienced GP, voluntarily retook MRCGP last year ­ 13 years after passing it the first time. I am relieved to report that I passed. And I made a few surprising discoveries.

The first time round

I am a 40-something woman. I crossed the path into general practice without any exceptional or interesting diversions, and arrived as a GP partner in 1992 with only the MBBS and MRCGP to my name. Having passed the exam in 1992, I felt justified to use the MRCGP initials after my name. The exam had been hard work and costly, and I did not have any other initials to make me look impressive on our headed notepaper.

However, I declined paying my subscription to the RCGP, as at the time it seemed to me the college had little to offer to the 'man in the street GP' other than a dull journal and London accommodation ­ which at its best was elusive.

Three children and several thousand patient consultations later, and without any significant break in service, I found myself in 2003 as a newly accredited GP trainer. It was at this point that my conscience got the better of me. With the additional fear of a newly emerging RCGP police force checking that members using the initials were in 'good standing', I abandoned my principles and decided to pay up.

Worst fears confirmed

It became clear with a registrar in tow that my competency as a practitioner at this point had fallen into unconscious mode. Repeatedly I found myself faced with questions I couldn't answer. Was this unconscious competence ­ I had become so skilled ­ or might I be unconsciously incompetent?

The best way to restore faith in my own abilities seemed to be to put myself in my registrar's shoes ­ and retake the MRCGP.

The MRCGP exam comprises four modules, and 75 per cent of registrars sit it. In 2007 the assessment process to certify competence as a independent GP and membership of the college are to be unified.

In its current format the exam involves a three-hour MCQ paper, a three-and-a-half-hour written paper, a video assessment and an oral exam. I omitted the video assessment for practical reasons.

Brushing up my skills

I took a month's extended study leave and worked alongside my registrar. I slipped in at the back of an MRCGP preparation course ­ trying hard not to look too geriatric ­ and attended a 'hot topics' course.

I soon realised there were limits to what I could learn. I didn't learn every medical condition known to man, which is what I had hoped for. Although I suspect my general medical knowledge base is now more substantial, I still find myself daily faced with clinical dilemmas that perplex me, and questions from my registrar that I cannot answer.

The things that I did learn surprised me and have been much more valuable.

·I learned what a valid, highly regulated and high-quality exam it is.

·I learned an enormous amount about how to gather good-quality, evidence-based material.

·I gained a much better understanding of evidence-based medicine, and have become much more discriminatory over the evidence presented to me when making clinical decisions.

·I reviewed the strengths and weaknesses in my consultation skills, and have discovered new concepts and dimensions.

·I have learned how difficult, stressful and burdensome doing the MRCGP is for our


·I found studying mid-life enjoyable and invigorating. I have been left feeling revital-ised mid-career, and it has given me great street cred with my registrars ­and my teenage sons who are studying for their


·I've been left thinking the RCGP isn't

that bad after all. It supported my unusual request, although it did take a little


You could do it, too. I would recommend retaking the MRCGP or something similar. Activating my grey matter beyond what we were having for dinner that night, and how many QOF points we had this year, was very rewarding. Revalidation is just around the corner, and is undoubtedly going to involve a knowledge test of some sort.

Maybe you all know more than I do so it won't be a problem. But doing the exam for a second time has dispelled my fears that my clinical knowledge is lacking, or that I am no longer capable of studying.

Karen O'Reilly is a GP trainer in Hampshire and has recently qualified as an RCGP examiner

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