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Preparing for the written paper in the MRCGP

RCGP examiner Dr Daryl Goodwin gives some tips from the inside

RCGP examiner Dr Daryl Goodwin gives some tips from the inside

Your first port of call should be the RCGP website to study the exam regulations, syllabus and questions and answers from previous papers. The exam overall is designed to test the attributes of what is considered to be a good GP:

  • factual knowledge;
  • evolving knowledge (including 'hot topics');
  • the evidence base of practice;
  • critical appraisal skills;
  • application of knowledge;
  • problem solving;
  • personal care (patient centredness);
  • written communication;
  • verbal communication (especially the consultation);
  • the practice context (teamwork and similar);
  • the wider context (medicopolitical, legal and societal issues);
  • ethnic and transcultural issues and self-awareness.

Critical appraisal

The paper is set and marked by working GPs (unlike the machine marked paper) and the issues are generated by things that may have arisen in their practices. There are 12 questions and a minimum of four will test how you evaluate and apply evidence. Critical appraisal skills are fundamental and will help you throughout your career with a changing knowledge base and evolving attitudes to interventions. I recommend How to Read a Paper: the Basics of Evidence-based Medicine by Trisha Greenhalgh, BMJ Books, as an accessible and comprehensive text on this topic.

The papers selected as source material in the written paper have come from a wide range of publications. What is important is the application of the skill rather than knowing all the pros and cons of the whole paper, although it is undoubtedly helpful, if only in terms of speed, to recognise the source material. You ought to be familiar with the 'landmark' papers that have influenced thinking and practice.

  • SIGN (Scottish Intercollegiate Guideline Network) is a good source of these references as they also simplify things for you by quoting the level of evidence.
  • Bandolier is another user-friendly site with critical appraisals (Critically Appraised Topics ­ CATs) that will give you a range of things to know about. However this site is not so general practice orientated.
  • The Cochrane Library of systematic reviews is another source of evaluated and high-quality evidence-based knowledge to learn to apply with the individual patient.

If the evidence base is the science of primary care, the application to the individual in their context must be the art. Think of the issues and exceptions when you see patients in your practice and how you negotiate the best solution with them. This sensitivity, flexibility and application of knowledge should then come to you without effort when writing your answer in the exam.

Clinical knowledge

Several questions will deal with clinical situations. While the knowledge base is not as explicitly tested as in the machine-marked paper, it is still necessary to have a background of knowledge to answer these types of questions. Remember that therapy has a wider meaning than pharmaceutical preparations. You ought to at least be aware of complex patient management, even if you have limited exposure to these types of patients. When the examiner reads an answer on these types of questions, there is a noticeable difference between those who have dealt with the problem for real compared with those who are relating to the issue only in the abstract, and possibly considering it for the first time.

You can get more experience by taking part in a significant event analysis and by asking experienced colleagues for advice or to share their experience on 'difficult' or 'challenging' patients.The other main topic area concerns practice administration and the medicopolitical and medicolegal aspects of primary care. Pulse carries regular features on these and our letters pages carry much debate. Most publications will cover the range of topics in a three-year cycle, so reading regularly throughout a three-year VTS will equip you for most topics that might arise.

Console yourself that if the topics you have prepared for the written paper do not come up, they might in the orals. Preparation is the key to passing but don't let that distract you from your main task in vocational training ­ preparing to be a good GP.

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