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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)

  • For the past 5 years I have been witnessing how the most knowledgeable GP trainees have been discarded from training by the biased CSA exam and on the other hand how the poorest trainees are passing this exam with flying scores!

    I have witnessed the CSA exam in USA, where they mark fairly and everyone with the basic knowledge and a bit of good practice can pass that on their first attempt, as they deserve. Whereas in UK, the best GP trainees have failed CSA after their 3-5 attempts despite having best preparation and following the best consultation skills/guidelines and changing strategies which never changed their marks! How is this possible?

    My question is why RCGP has not been showing any flexibility in incorporating the feedback of many experts/doctors to rectify this dilemma and save the whole profession?

    Why such a huge number of good doctors who were trained in this country and are familiar with British culture are discharged from training with no option left. RCGP does not seem to be touched.

    Why RCGP has decided to fill the created gap in workforce by bringing GPs who are trained in Eastern Europe or India rather than using those British doctors already trained within the system in order to alleviate the situation?

    All in all, I am requesting RCGP to find the quickest way to rectify this disasterous exam and find a fair way to bring back those doctors to the GP profession as our country now is in the highest need of them.

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  • 20 patients a day,if only.40 or more,with additional,visits,results,letters to code( 30-50)'results to decipher 30 or more,practice admin,staff issues,business issues,phone calls and queries.Way way to much work to manage.I wonder why recruitment is so dire!!!!!!!!!!!!

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  • Another concern is that when it comes to medical defence relating to practice of non GP professionals the responsibility comes back to the partners to respond to the complaint. So we are responsible for our own practice but also for supervision of allied professionals who should be working independently. All this at a time when workload is already unmanageable and there are fewer and fewer GPs to carry the burden

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  • Its very unfair that a doctor who has spent 5 years studying medicine and then worked as trainee in NHS at different level for 5 + years, who has showed continues progress and marked competent to work as GP on work place based assessment, is deemed unsafe just based on doctor getting just 1 mark less in acting based CSA exam.The doctor is denied oppertunity to work in trained speciality labelled unsafe while physician assosiates with no medical degree and just 2 years training and no MRCGP can work in general practice.Is patient safety not compromised with PA' s working in general practice?

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  • Una Coales. Retired NHS GP.

    I commend BAPIO (British Association of Physicians of Indian Origin) for taking the RCGP to High Court over the acting CSA exam. A moral victory was needed to expose how failure to control unconscious bias may have resulted in the huge disparity between white and non white doctor pass rates, which had not existed when real patient video consultations were used to assess doctors for the MRCGP exam. It is incredulous that the acting CSA exam is still operating in the 21st century. IMO Martin Luther King Jr would be turning in his grave.

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  • As a GP very near retirement I have the advantage of historical perspective even though I am not currently involved.
    My concerns are more about the content of general practice than the method used to assess it. The exam has been obsessed with the consultation for decades, quite appropriately two decades ago, but (though still of vital importance) less central now that the content of primary care has shifted so much. Dealing with complexity is now the most challenging aspect of primary care and the importance of the GP role as conductor of the diagnostic/therapeutic/caring orchestra needs to be moved to the epicentre of the MRCGP exam. This involves holism in the traditional sense, but with the addition of ensuring the unified working of the other health and social care professionals to avoid gaps in care, wasteful overlap or, worst of all unknowing clash of incompatible interventions. The challenge of therapeutics has never been greater, and cannot be totally relegated to pharmacists or nurses or hospital specialists. The only person with the complete therapeutic score on his/her desk with a knowledge base to evaluate it is the GP. And this means that GPs need to have a much more extensive knowledge of therapeutics than has previously been necessary. Team working has always been a characteristic of quality primary care, but teams are now bigger, more diverse and often multi-sited and multiagency. Taking global responsibility for the patient, especially those who lack capacity, is essential to avoid fragmented care, and the GP is the obvious and most appropriately skilled person to take this role. But so doing requires formal continuity of care, which is under threat from part-time and casual working health professionals. Organisation of practices so as to provide continuity of care in the face of discontinuity of staffing is one of the most pressing problems. It is achievable but requires sophisticated practice management and an ethos of joint working. Out of hours care has become a black spot in primary care, a casualty of underfunding, privatisation and the loss of GP direction. Quality has suffered, and the lack of investment in academic study of out-of-hours care means that there is little evidence that can direct the organisation and provision of service. Yet the use paramedic response teams in this area leads to waste, unnecessary hospital admission and poor quality holistic care. General practice must aim to take back control of this area of care, and the membership exam needs to recognise its importance.

    These are difficult times for general practice, but if we are to preserve our discipline, which is capable of providing high quality patient-sensitive, effective and efficient care at remarkably low cost, my successors need to focus on the areas of care that generalists are most suited to provide. We must also ensure that the high standards of the MRCGP exam are relevant to the job description of sort of GP needed in the future.

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  • Everyone knows its just a money grab from BME, especially BME international graduates by all Colleges. That simple. Nothing more nothing less. This has been going on for decades with every college!! How else would the college get funded with ever dwindling membership? Many leaving country and many leaving the membership inside UK.
    I still remember a quote from a Female hospital colleague, " He was my reg, when I was SHO. He knows a lot more than anybody I knew in this whole hospital. But he failed and I passed. I know they make it difficult for you guys to pass."

    Make few rules - reduce the exam fees, none of the fees from exams goes to Colleges for any expenses other than trainees, reduce the pay, no luxury biscuits, no natural mineral water - (just tap water is enough), no five star treatment or accommodation paid for for GP examiners, stop hiring Royal stage actors for exam - everyone would pass first time. Stop the exams being a business opportunity and profit based exercise for colleges.

    If you want to test communication skills and English language ask candidates to take IELTS - standard English test all over the world.

    CSA exam has no real world bearing either for communication skills or medical knowledge. CSA is biased exam. So is AKT. Asking non-english native speakers to do a english reading game with complicated sentence structure and asking them to differentiate between false negatives and untrue non-positives and shorter time limit. Not actually a test for clinical knowledge in true sense.

    Just a game.

    P.S - I took exams with 3 different royal colleges. Above info is from real world personal experience.
    Thanks Una for remaining in touch with this wretched world.

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  • The review has been going on for more than 7 months. Anyone have an idea when this review will be out ?

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