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What to expect with the nMRCGP exam

Dr David Sales, RCGP medical director of assessment, lifts the lid on the new exam and answers some common questions

GP training is undergoing a complete overhaul, and in the next couple of years summative assessment and MRCGP will be combined in one new exam ­ nMRCGP. Most registrars starting this month will sit summative assessment before it finally dies out and you will still be eligible for MRCGP as well if you get your skates on. But you can opt to take nMRCGP and applications will be accepted from February.

Why the new exam?

Neither the current summative assessment or MRCGP exams would in future satisfy the Postgraduate Medical Education and Training Board (PMETB) ­ the new statutory body that oversees postgraduate medical education and training. The decision was made to improve and streamline medical teaching and assessment across specialties, moving to an outcome-based approach, using specified knowledge, skills, behaviours and attitudes defined by and mapped to the new RCGP curriculum and spanning the whole training period.

There was also growing unease that traditional competence assessments were skewed towards that which is measurable ('can do'), rather than importantly demonstrating performance in reality ('does do').

The pass mark will not be set before the exam is fully developed and great care will be taken to ensure it is appropriate and acceptable to all stakeholders ­ including patients and trainees.

The exam in detail

Workplace-based assessment (WPBA) is the evaluation of a doctor's performance and their progress over time, in areas of practice best tested in the workplace. This will bring general practice in line with other specialties and the foundation programme.

Teaching, learning and assessment will be closely linked in the WPBA by gathering evidence of actual performance in the workplace and allowing assessment of aspects of professional behaviour that were impossible in traditional assessments.

The structured trainer's report will be replaced by the competence-based enhanced training record (ETR), which effectively will be a portfolio (logbook) of evidence.

The evidence may be collected informally or using assessment tools in the workplace. The assessment tools being piloted include multi-source feedback, case-based discussions and a consultation observation tool including the use of video and patient satisfaction questionnaires.

The video will continue to have a key role in nMRCGP both by giving valuable feedback and for making judgments using the consultation observation tool.

The WPBA pilots will be completed by September and then the precise composition and blend of assessments will be decided. As WPBA is the evaluation of a trainee's progress over time it cannot be taken before the other assessments and will be signed off in the final period of training.

Clinical skills assessment (CSA)

The CSA is designed as an end-point assessment of a doctor's ability to integrate and apply clinical, professional, communication and practical skills appropriate for general practice. The CSA will include assessment of:

·data gathering, technical and assessment skills

·gathering and using information, choice of examination, investigations and their

interpretation, demonstrating proficiency in performing physical examinations and using instruments

·clinical management skills ­ recognition and management of common medical

conditions, decision-making, the ability to deal with complexity, multiple complaints and risk, health promotion

·interpersonal skills ­ attitude, approach and communication; communication with patients and the use of recognised

communication techniques, practising

ethically with respect for equality and

diversity, in line with accepted professional codes of conduct.

The CSA will be in a multi-station OSCE format. Each station ­ probably 14 of them, each lasting 10 minutes ­ will be presented as a clinical encounter using simulated patients. Feedback from trainees following the first pilot suggested the CSA 'felt real' and reflected a day in the life of general practice.

A CSA 'dry run' is planned at the University of Warwick in September and we are looking to recruit trainee volunteers (contact who either would fulfil the future CSA eligibility criteria or have recently sat summative assessment and/ or the MRCGP.

Applied knowledge test (AKT)

The AKT will be an end-point assessment to confirm the possession and application of the breadth and depth of knowledge that would be expected to underpin performance in general practice in the UK.

The AKT content will include core clinical medicine and its application to problem solving in a general practice context, critical appraisal and evidence-based clinical practice and health informatics and the organisational structures that support UK general practice. Topics tested will be those that are common and/or important.

These will be defined by sampling the curriculum and will be designed to reflect work in UK general practice. Typically questions will be presented as clinical encounters and will assess application of knowledge to clinical management.

The last summative assessment MCQ will be in May 2007. After that all doctors will be required to sit the AKT, which will be available from October 2007. The AKT is likely to be the same length ­ a 200-item three-hour test that provides sufficient content coverage and good reliability.

It will use the same format as the current MCP, using single best answer and extended matching questions and it will have a similar proportion of questions with about 80 per cent relating to core clinical topics and around 20 per cent to critical appraisal, evidence-based medicine and organisational issues

It will be offered three times a year in February, May and October; timed to meet demand.

Transition arrangements

The regulations for registrars already in training at the time of the transition to the nMRCGP will be flexible to ensure no groups will be disadvantaged. Registrars who begin training before August 2007 and have completed at least one component of summative assessment by 31 July 2007 will have until 31 July 2008 to complete summative assessment.

Registrars who have not successfully completed any summative assessment module by 31 July 2007, or are unlikely to complete GP training before 31 July 2008, would be advised to take the nMRCGP. The current

WPBA proposals will replace the structured trainer's report with an enhanced training record and a range of assessment tools to be introduced from August 2007.

The rules and regulations are being finalised, but it is likely that trainees will be eligible to take the CSA after completion of their first GP post, and having completed 18 months of their specialist training.

David Sales is a sessional GP in West Sussex and newly appointed medical director of assessment for the RCGP, developing the new exam

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