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Independents' Day

RCGP reviewing whether MRCGP exam is ‘fit for purpose’

Exclusive The RCGP has drafted in consultants to carry out a ‘comprehensive review’ of its controversial MRCGP exam, which will look at whether the assessment is ‘fit for purpose’.

It is also looking at whether ‘fairness to candidates’ is sufficiently considered at ‘all stages of test design and delivery’, following controversy around the gap in pass rates between white and BME candidates.

The college said that it is undertaking the review now because the exam has been running for 10 years and is ‘therefore at an appropriate point at which to evaluate its content and structure’.

It is also ensuring that the exam is in line with the GMC’s revised standards for postgraduate curricula, published in May.

The Health Professional Assessment Consultancy has been appointed is to review the MRCGP assessment – including the Applied Knowledge Test (AKT), the Clinical Skills Assessment (CSA) and the Workplace Based Assessment (WPBA) - and suggest potential changes.

According to a paper presented at this month’s RCGP council meeting, the review is expected to include answers to the following questions:

  • Is the current programme of assessment fit for the purpose of a postgraduate medical license?
  • Are there emerging evidence-based assessment methodologies that the RCGP should consider to ensure that the MRCGP remains fit for purpose and adaptable?
  • Does the programme of assessment meet the requirements of the GMC’s Standards for Curriculum and Assessment Review, including the proposed General Professional Competences?
  • Is fairness to candidates sufficiently considered at all stages of test design and delivery?
  • Are the current standards appropriate to ensure patient safety?
  • What enhancements to test development, standard setting and quality assurance methodologies might be appropriate?

The MRCGP has come under fire in the past on a number of issues. In 2015, Pulse reported that the BMA had concerns over perceived high fees.

Meanwhile GP leaders have previously called on the RCGP to look at reforming the training process, with former college chair Professor Clare Gerada questioning the necessity of the CSA aspect of the exam.

And the exam has been the subject of a long-running dispute about the differences in failure rates between UK white and BME graduates and international medical graduates, which sparked a judicial review hearing instigated by the British Association of Physicians of Indian Origin (BAPIO) in 2014.

The review ruled that the exam was lawful but the judge stressed that the RCGP needed to ‘eliminate discrimination’ in the MRCGP and tackle the differences in failure rates between white and non-white medical graduates sitting the CSA.



Readers' comments (38)

  • Cobblers

    It would be better if the review was

    "If the RCGP is fit for purpose".

    COI am not and never was a RCGP doctor. I had the option of taking the exam but at that time it was not a de facto pass requirement for GP Training.

    I did not like what I saw in the early 1980s. I like it even less now.

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  • RCGP is suffering with a massive case of unconscious bias.

    CSA is easy to pass if you stick a hot potato in your mouth.

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  • This comment has been moderated.

  • What purpose?
    Is it to demonstrate a knowledge of academic papers, and thought, in relation to the field of primary care
    Is it to validate the ability to diagnose,run a practice,and hit sufficient targets to maintain financial viability
    Bear in mind all CSA consultations are by definition incompetent, since no record of any is ever made.The MDU would decline to defend any consultation along CSA lines, if it were with a real patient

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  • It isn't. Go back to summative assessment and MRCGP if people want to bother. This was all about RCGP taking control.

    DOI: MRCGP(2008) no longer a member as it delivers little of benefit I can see.

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  • Much that I do not think the MRCGP is fit for purpose. I can't help but feel the GMC being involved brings in a political element where they will try to water down standards to allow non medics to attempt college exams.

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  • Jo Smit, you may have a point there.

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  • agree, not fit for purpose. huge subconscious bias in CSA

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  • You pass CSA if you know to 'act' and prepare to fail if you apply some sense as you do in normal practice.

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  • Interesting development and an indicator that the 'college' knew that thair CSA exam stank all along. (And no I'm not an IMG who wants justice for being taken for a ride and having my life ruined by these cowboys).

    Rather than being obsessed with being in London, if the RCGP relocated to a more sensible accessible location like the midlands they wouldn't have to pay such a huge mortgage on their prestige building? Then perhaps exam fees could come down and the feeling that the RCGP exploits its trainees, is self serving and doesn't give two hoots about its members or having hugely expensive dysfunctional exams which aren't fit for purpose in the first place,might change.

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  • Agree with Jo Smit - I have concerns about the MRCGP and particularly allegations of subconscious bias (DOI - I'm white and I passed it) but I also feel that at a time where the traditional GP role is being taken on by other clinicians (nurses, PAs) that we should be ensuring that a newly trained and qualified GP is at a sufficiently high standard to justify that role and salary.
    I would have concerns about moving back to a purely workplace based assessment system, as it is too easy for struggling trainees to be pushed through as "that's the easy thing to do". This will only become a bigger problem as our workload increases and intensifies as we will have less capcity (time, mental etc) to tackle the difficult trainees.

    Also as private providers increase their foothold in GP I wonder whether they will also take on any roles in training, and I would imagine that in that environment this could be an issue as well.

    I'm glad they're looking at it at the very least but I worry that the pendulum may swing too far in the other direction.

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  • Vinci Ho

    (1) Allowing more non-medics to become doctors and then GPs seems to become an inevitable reality . This government must bear the responsibility on all the consequences, whatever they are.
    (2) One examination to judge is always subjected to controversies. Unconscious bias was the legal diagnosis from court on MRCGP examination. Inaction to, at least , provide an alternative is in fact continuing to erode the credibility( whatever is left)of the college .
    (3) Funding more education programmes to help new MRCGPs for further development in general practice is more essential. Learning never stops after completing an examination.

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  • It is standard practice to do a review. The GMC is involved because they set all standards for postgraduate exams.
    There certainly maybe unconscious bias acting but it does not explain why certain ethnicity does less well in machine marked papers. That is the crucial question.

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  • I suspect the examination needs to be made easier to help facilitate the recruitment drive for GPs and what better way to do these by announcing a ''review''

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  • Tom Caldwell

    Fitness for purpose after it's been going a long time. Probably standard practice. But a headline that does not engender confidence in RCGP.

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  • I think it is a fairly good assessment but it is difficult..and expensive

    I worry about the unfairness of it when they are shipping in unqualified GP's from Europe in countries where they dont have VTS schemes and haven't done exams.They are bypassing the system and seem to be able to practice without the MRCGP.

    Also there plenty of nurse practitioners who are practising on undifferentiated patients with a fairly minimal course....

    It all seems a bit unequal, unfair.

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  • Well if non-medical professionals can practice but those who marginally failed CSA can't, what can possibly be considered as a reasonable purpose achieved by the system? How is the fitness for purpose going to be assessed we'll probably never find out. Hasn't RCGP quite clearly already failed it's purpose by all methods of measurement? Don't we already know what the result of this assessment is going to be? Oh well, it really looks like nobody is genuinely touched by any common sense. Failing MRCGP by 5 marks makes you incompetent to practice as a GP while non-medical professionals are sought after in order to put things right. Is this not in itself a system failure?

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  • There is no doubt that it's a biased depends on your colour ,sex and how good is your acting.

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  • Complete shambles - always has been and likely always will be - only remarkable in that RCGP and GMC presume themselves to be standards of quality but are infamous for only maintaining their own accelerating dysfunctionality.

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  • Maybe a review allows them to charge even more! That wine cellar won't fill itself and the cardies may be forced to actually do some clinical work if they're not sitting in London weaving baskets and planning "training" whilst we all sink ever deeper...

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  • The CSA is not a perfect exam but is better than nothing. It is pretty straight forward - 1 problem per 10 minutes, minimal examination as the patients are actors and no notes to record. It is very expensive, however. The concern, as mentioned previously, is the push for GPs from the EU, some of whom have little or no postgraduate qualifications or evidence of basic competence. I worry about clinical standards and the knock on effect this could have for the profession as a whole.

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