Passnotes: how to prepare for the MRCGP oral exam
With the MRCGP oral exam looming, Colonel Robin Simpson offers tips on how to impress the examiners
The oral module of the MRCGP is best taken towards the end of general practice training or perhaps as the last module. This gives candidates a chance to mature and approach each question from the perspective of a thoughtful GP recognising many options for presented dilemmas.
Plenty of practice is the key to passing this module. Preparation is usually best done in small groups discussing all aspects of the work of a UK GP along the lines of Good Medical Practice1. This document is subject to review and candidates should keep themselves up to date. Candidates will be asked to apply an ethical framework to an answer and therefore it is well worth practising this with colleagues.
Candidates should aim to attend at least one session of mock orals. Ask your colleagues for feedback on your performance: do you have any annoying habits likely to distract the examiners? Can they think of options you have not thought of?
Remember that an examiner can construct questions right up to the day of the oral examination so read the latest copies of the BMJ and British Journal of General Practice. They are the journals examiners are likely to have recently read. You don't have to remember exact references but if you can and they are relevant, they are likely to help your mark. Candidates should be familiar with major events in medical politics such as the Chief Medical Officer's report Good Doctors, Safer Patients.
What is decision-making?
This module of the MRCGP tests a candidate's ability in 'decision-making skills and the professional values underpinning them'. No model of decision-making is stipulated in exam regulations but most GPs use the one based on Pendelton's model of the consultation – in which the doctor enables the patient to choose an appropriate action for each problem. This is achieved by considering options and implications and then choosing the most appropriate action.
Literature from the business world stresses the completeness of the decision-making process with no major decision being made without all stages being thought through. The adapted business model is particularly useful as it breaks decision making into eight stages. Furthermore it is an expansion of the model already known to GPs.
Candidates are encouraged to familiarise themselves with a decision-making model and use this for the basis of their answers. It should be remembered that there are no correct answers to difficult dilemmas. However, examiners will be more impressed the more options, and implications of those options, that the candidate gives. Candidates should resist jumping to a conclusion until pushed to do so by an examiner. Then the candidate must make a final decision on the dilemma and justify their decision perhaps also with reflection – that would be a perfect answer.
If you have a strong ethical viewpoint on a particular topic, that will be respected by the examiners. However candidates will also be expected to be aware of other options that could be expected if discussed with 'a body of GPs'. I would encourage candidates to give the impression of a thoughtful GP guided by ethical principles.
On the day
The oral should be considered to be a professional interview so dress accordingly and arrive in good time.
The MRCGP oral module is a rigorous assessment of the candidate's ability to make informed decisions about all aspects of general practice. Well-prepared candidates should have no problems in passing this examination. Familiarisation with the examination regulations and plenty of practice is essential. The pass rate this summer was 75 per cent.
1. An Insider's Guide to the MRCGP Oral Exam, 2003, Radcliffe Medical Press. A videotape of some typical orals, and an accompanying book.
2. Concepts and Answers for the MRCGP Oral Exam, 2005, by Prashini Naidoo and Andrew Davy, Scion Publishing. Provides a useful list of likely topics for the MRCGP oral, although concentrates on fact rather than advice on exam technique.
3. The Complete MRCGP Study Guide, 2004,
by Sarah Gear, Radcliffe Medical Press.
The author recently passed the MRCGP
herself and offers good tips on what she found useful in her preparation for the whole MRCGP.
Robin Simpson is the Defence Professor of General Practice at the Royal Centre for Defence Medicine. He has been an MRCGP examiner since 1995 and is also a member of the Oral Core Group of the Panel of Examiners