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MRCGP to nMRCGP a smooth transition

Lost in the maze of different MRCGP assessments?Dr Andrew Wilson guides you through

GP and specialist training is in the process of a massive change. Modernising Medical Careers has redesigned the training pathways for all specialties including general practice. With the changes in the curriculum and how it is delivered come changes in how GPs will be licensed to practise. All GPs now need to be both fully registered with the GMC and on the GMC GP register.

The new route

In future the route for newly trained doctors to become licensed and added to the GP register will be nMRCGP. This includes tests of competence and performance. There will be an applied knowledge test (AKT) in MCQ format, a clinical skills assessment (CSA) using role-playing patients and a workplace-based assessment (WPBA).

The latter will build on the type of assessments used in the foundation programme. Examples will include a patient satisfaction questionnaire, multi-source feedback, case-based discussion, direct observation of practical procedures, consultation observation or mini clinical assessments and a satis-factory clinical supervisor's report.The doctor will collect the relevant evidence as they train using an electronic portfolio. These assessments in the workplace will run throughout the training programme with periodic reviews.There will be an overlap between the old and new assessments. WPBA will be available from 1 August 2007, the AKT and CSA follow in October 2007. The current MRCGP will continue into 2008.

Old or new route?

The RCGP gives the following advice on its website. 'The new assessment process, the nMRCGP, will start in August 2007. For doctors completing their GP training in February 2008, this would only allow six months to undertake the whole of the new assessment.

'WPBA is intended to cover the whole three years of training, so it would be difficult, if not impossible, for trainees to complete this component plus the CSA and the AKT in just six months. Therefore, doctors finishing training in February 2008 should complete the summative assessment (SA) application form and send it to their local deanery as soon as possible.'These doctors are strongly advised to sit the final SA MCQ in May 2007. They could do the MRCGP MCP if they wish but should note that it is pitched at a different level from the SA MCQ. Anyone who fails at this stage will then have to take the AKT in October 2007. A pass in the AKT will count towards both SA and MRCGP.  'In addition, all of these doctors (except those doing the Leicester simulated patient surgery) are expected to submit their videos via the MRCGP/SA single route video. The SA-only video will not be available from August 2007.'And finally, the transition documents originally stated that 'a GP registrar has to have completed a component of SA by 31 July 2007 to be able to continue down that route'. It has recently been agreed to amend the wording, so that anyone who has started down these old assessment routes, or has expressed an intention to do so (for example, by completing the SA application form) should be allowed to continue.This ensures that those who may fail the SA MCQ in May can continue down the SA/old MRCGP route. The MRCGP video and MRCGP MCP are both approved as SA methods, so therefore count as SA components for this purpose.Those completing training in August 2008 and thereafter should take the nMRCGP route. WPBA is designed to run throughout the three years of specialty training. In this transition phase evidence from the final year will be sufficient if it is supported by appropriate documentation from posts undertaken in the preceding two years.Those completing their training after February 2008 and before August 2008 are advised to take SA and, if they wish, the MRCGP. Those finishing just before August 2008 may opt to take nMRCGP.Those on accelerated training (such as those having undertaken GP training abroad and requiring just six months UK training) should at present take SA and, if they wish, the MRCGP. Work is under way to devise a performance assessment for them based on WPBA but attainable in the six months of their training. The MRCGP allows candidates up to three attempts at each module and we plan to continue this during the transition period. The last time candidates will be able to make a first application to take the MRCGP will be Wednesday 29 August 2007, the closing date for the winter 2007 round of the examination. Anyone who fails to achieve a pass in any component will then be permitted to make two more attempts, one in spring 2008 and one in winter 2008. For some of the modules parts of the new exam will be substituted from October 2007. Hence anyone taking all three modules in winter 2007 will have up to three attempts at each module or its nMRCGP replacement.However, if you register for the winter 2007 exam and decide not to take some modules you will then have only two rounds left to take them in. It would therefore be sensible to attempt all modules by winter 2007.The AKT and CSA sound similar to the old MRCGP MCQ and simulated surgery. The formats will be similar. The AKT should be available at local professional computer-based testing centres rather than distant exam halls from the October 2007 sitting. The new AKT will have more questions on clinical practice and fewer on research, statistics and practice organisation than the old MRCGP MCP. The current simulated surgery was designed as a test of consulting skills. The CSA will look at your integrated approach to the consultation, including both your communication skills and your clinical skills. The candidate will stay in a consulting room with role-players accompanied by an assessor coming to the candidate for 10-minute consultations. There will be 13 consultations for each candidate.

Will the new assessment be easier or more difficult?

The benchmark for the nMRCGP will be set at the standard required for safe independent general practice in the UK. There will be no pass or fail quotas in each assessment – all those reaching the required standard will pass.

The standard will not be based on the old MRCGP or summative assessment.

Dr Andrew Wilson is convenor of the panel of examiners for the MRCGP

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