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Top tips for passing MRCGP

Step up your preparation for the oral examination with advice from course director Dr Nigel Giam

Format

With the written paper over and video submissions complete, GP registrars have a little time to relax before the viva module. This is assessed about six weeks after the written paper – this year from 18 June to 1 July.

The viva can be taken in London at the RCGP or in Edinburgh. There will be two oral exams, each lasting for 20 minutes. In each you will be asked five questions lasting four minutes and alternating between two examiners.

The questions

The questions are based on areas of competence in different contextual areas. Some examples are given in the table below.

Each candidate should be asked 10 questions, testing a different area. In areas of competence, questions around professional values often have strong ethical themes. These questions often make the candidate feel uncomfortable. The goal is to identify why this should be and how to address and take responsibility for the dilemma.

The examiners

Examining styles will vary. Inevitably there will be 'doves and hawks'. The examiners will attempt to rate the candidate early in each question. If the question seems to be getting more challenging this may well be because you are being pushed for a merit. On the day, maintain good eye contact with the examiner who is asking you the question. Do not look for acknowledgement from the other examiner – you are unlikely to get it.

The grades

Each examiner will grade you on your performance. Grade options are:

• O – outstanding• E – excellent• G – good• S – satisfactory• B –borderline• N – not adequate• U – unsatisfactory• P – poor• D - dreadful.

Exam technique

Practice is key. Fluency in what you say and how this comes across play a great part in succeeding in this component. Practise the viva in a study group if possible, with two of you acting as examiners and alternating questions. If you don't have a study group, practise in front of the mirror. Practise talking through problem types and ethical scenarios out loud.

You will inevitably feel nervous on the day. Before you start answering a question it is important to take a few seconds to digest it. Ask yourself the following:

• Can I identify the dilemma?• Can I see both sides of the argument?• How will I justify my decision?

Remember that model answers for the viva do not exist. The examiners are assessing the way you come to a decision using sound principles. Applying frameworks to every question is likely to produce unrealistic and artificial answers. In particular do not use buzz words like autonomy or equity if you are unable to justify what you mean by them.In short, when you are asked a question:

• consider• decide• justify.

Example question

Apply the approach above to the following example question: A patient who you have looked after comes to see you with a gift. How would you respond?

Think!

What is the dilemma? Whether to accept or decline the gift. What are the implications of accepting or declining?

What other factors need to be considered before making a decision? Can I justify my decision?

Do not:

Do not pass the responsibility of decision making, for example by saying 'My decision would depend on the practice policy'. For exam purposes there is unlikely to be a generic practice policy.

Do not rely on quoting BMA or GMC guidance without demonstrating any self-awareness – this will give a very stiff answer. For example, saying 'GMC guidance stipulates I should not accept a gift and so I would not accept the gift'.Also do not list a lot of issues for the patient, doctor, practice, society and so on, as this is not what is being asked of you.

Common reasons for failing

The viva tests decision-making skills, so candidates who fail to do this will perform poorly. Candidates often fail because:

• justification for decision-making is lacking• their thinking was too rigid and inflexible• they were unable to identify the issue• they made a dangerous/illegal decision.

Results

These are generally issued three weeks after the exam, both on the RCGP website (www.rcgp.org.uk) and by first-class post. The website gives details for passes for individual modules as well as overall, with separate lists for merits and distinctions. Good luck!

Dr Nigel Giam is MRCGP course director for the RCGP London faculties

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