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Tips on passing the nMRCGP: an introduction

Dr Una Coales kicks off her new series of tips on how to pass the nMRCGP exam with an introduction to the exam requirements and a well-reasoned plea for good manners among candidates.

Dr Una Coales kicks off her new series of tips on how to pass the nMRCGP exam with an introduction to the exam requirements and a well-reasoned plea for good manners among candidates.

The n(ew) MRCGP exam begin in October 2007 and represents the licensing exam for all UK GP specialist trainees. It comprises two main elements, the applied knowledge test (AKT) and clinical skills assessment (CSA).

The AKT is modelled on the old MCQ paper but is now computerised and the CSA is modelled on the old Simulated Surgery module (with 12 stations and 10-minute consultations).

Those who do not clear this exam may not obtain their Certificate of Completion of Training (CCT) and may not work in the NHS - a position which, ultimately, isn't much different from the increasing numbers out there who do have nMRCGP, are unemployed and in debt. But that's another story.

The RCGP's spring 2008 AKT results show a 1st time pass rate 85.5% and 2nd time 66.3%, and the CSA results a 1st time pass rate 81.3% and 2nd time pass rate 63.7%. Interestingly, the RCGP also published the pass rate for white candidates of 93.3% for the CSA compared to a pass rate of 63.9% for Asian candidates.

Deaneries seem to be taking a 'get tough' approach to those who fail, with some trainees finding themselves appearing before 'parole' review boards to plead their case to receive extensions for failing the AKT module - which the deaneries have pegged as just a matter of book-learning.

Deaneries are not duty bound to continue supporting candidates, but have decided to grant automatic 6-month training extensions as more GP trainees started failing the CSA (clinical skills assessment) module. The CSA module alone costs £1,385 (rate April 2009). Those 5th-timers resitting AKT and 4th-timers resitting CSA are facing substantial financial and deanery pressures to pass nMRCGP.

Is this a case that not all GP trainees are suited to complete training to become GPs or is there something else underlying these exams that account for repeat failures? The latter I'd say!

Over the next 10 months, I shall share tips to help you pass the. And here's the first for the CSA: manners!

‘I have never seen such appalling lack of manners in my life,' a female examiner might think when seeing a male GP not show an elderly lady hobbling with a cane to her chair, much less help her out of it.

What a shame the culture of medicine does not include a lesson in manners. Some GPs fail to introduce themselves to patients. Gone are the days in which students would rise and say ‘Good morning Miss Smith,' to their teacher and wait to be granted permission to take their seats again.

And so too with the CSA. It's vital to remember your manners and your pleases and thank yous. It is polite to ask permission (use the ‘modal') when addressing our esteemed patients, ‘may I examine you please?'

How many GPs order their patients and for that matter, partners, around like children? ‘Come in!' as in 'I can't be bothered to get out of my chair and open the door for you, much less greet you with a handshake'.

‘You need to take this tablet!'

‘You need to do as I say as I am your arrogant authoritative doctor-centred GP!'

QED: the number one reason for failing CSA: lack of manners and being too doctor-centred.

About Dr Una Coales

In 1993, as a US surgeon, I sat my first ruthless UK postgraduate exam, the PLAB exam with its 5-modules, fail one module, re-sit all policy. I made a promise to write a book on this exam if I ever passed!


As I progressed through most of the UK postgraduate exams (including the masochistic FRCS exams), I wrote exam books along the way to help colleagues. In 2002, as I sat the MRCGP exam at the Royal Horticultural Hall amidst 400 GPs, I wondered what exactly had I revised over 6 weeks as nothing seemed relevant to the actual MCQ paper in front of me.


There were no RCGP courses or books on the Simulated Surgery module and not surprisingly, the RCGP published pass rates between 56% and 60%. These GPs (who could not video-tape) needed help and so between 2004 and 2009, I have been teaching all 5 modules of the old MRCGP (MCQ, written, oral, video and simulated surgery) and now solely on the new MRCGP exam (AKT and CSA).


Visit www.mrcgpcourses.co.uk for a full list of courses and books.

Dr Una Coales tips on passing the CSA (above) and AKT aspects of the MRCP exam

It's vital to remember your manners and your pleases and thank yous.

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