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Pass notes: What to expect in thesimulated surgery

The MRCGP simulated surgery is an intense three-and-a-half-hour exam to test your consulting skills ­ Dr Mei Ling Denney explains

The MRCGP simulated surgery is an intense three-and-a-half-hour exam to test your consulting skills ­ Dr Mei Ling Denney explains

The MRCGP simulated surgery is a high-level form of objective structured clinical examination, testing mainly consultation skills, but also some clinical skills. These have been put together to form a morning or afternoon surgery, lasting about three-and-a-half hours. In this surgery you can expect:

  • typical consultations found in UK general practice
  • 12 different cases, most of which have a degree of complexity
  • case notes giving you any necessary past medical history and drug history
  • childhood problems, usually in third-party consultations
  • patients from different social or ethnic backgrounds·possibly some disabled patients

The exam is held in Cambridge, in a college or a large conference centre. There will be exam marshals on hand to show you where to go and address any problems you may have. You will be directed to a room in which you will remain for the duration of the exam. The simulated patients and examiners will enter and leave at the sound of a bell or whistle. What you will not find is:

  • a computer or access to textbooks·medical equipment, so do bring your doctor's bag
  • babies, patients who cannot speak English and require a translator, very ill patients
  • a chaperone, as you do not need to perform any intimate examinations.

Being in a different environment from your normal surgery, it is important to try to feel relaxed, and as if you are consulting without being observed. Try to foster an atmosphere of realism by:

  • dressing as you would for a normal surgery
  • treating the simulated patient with exactly the same respect as a real patient
  • assuming you are not acquainted with the patient, and that you know nothing of their medical, psychological, or social problems
  • ignoring the examiner, and do not ask them any questions.

Further tips for success include:

  • arrive in good time, in order to be present for the candidate briefing
  • try to be patient centred in your consulting
  • don't overrun on time with history taking, as marks will also be awarded for your management plan
  • keep your clinical examination of the patient focused on the problem
  • make sure you leave your mobile phone outside or switched off to avoid distraction and risk of disqualification.

By the end of the surgery, you will probably feel quite tired, but do not leave the exam until a marshall says you may go. Take your belongings with you but leave any exam materials in the room. Before leaving, you may be asked to fill in a questionnaire giving your opinion on the exam ­ this helps give the examiners feedback on the cases, and any organisational aspects. From this we know that most candidates feel the simulated patients play their role very well, that although it is a difficult exam few candidates are stretched to their limit, and that the cases simulated are a good reflection of the work of an experienced GP.

Mei Ling Denney is a GP in Peterborough, and an examiner for summative assessment and the MRCGP

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