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This week RCGP chair

Dr Mayur Lakhani outlines the vital changes you need to be aware of in the assessment process

All doctors in GP training will be required to register with the RCGP

There are some radical changes taking place in postgraduate training and medical education for general practice. Of particular interest to registrars will be the new assessment process that will be introduced from 2007.

Here I outline some ‘must know' facts about this and the transitional arrangements for 2005 to 2007. The four improvements in training are shown in the first box below.

Reasons for change/importance of assessment

The Postgraduate Medical Education and Training Board (PMETB) requires an assessment programme for doctors training in general practice that meets its criteria (www.pmetb.org.uk). The RCGP will recommend that programme and standard. Central to this is ensuring that GPs are fit to practise and have achieved competencies that make them ‘judgment safe' and fit for independent practice.

The public must have confidence in this process. After all the stakes are high: general practice is a ‘hard' specialty – having to deal with a complex range of undifferentiated presentations. With more than 90 per cent of NHS work being done in general practice and nearly 750,000 consultations taking place with GPs on average on a daily basis, it is essential that new GPs are fit for purpose.

The assessment programme enables a registrar to show that he/she has met the standard required for entry on to the generalist register to be established by the GMC in 2006.

It is also recognised that the current system of assessment – MRCGP and summative assessment – is confusing and increases the burden on registrars. A single route is preferable. Also the current assessments do not include a test of clinical skills. For these reasons, the RCGP has worked closely with the Committee of GP Education Directors to design a new assessment system that meets the requirements of PMETB. Registrars, educators, assessors, and lay people contributed (and contribute) to the development of the new assessment programme.

The new assessment

The process is referred to as nMRCGP. This will be a new single assessment process for certificate of completion training (CCT) under article 5 of the PMETB order.

What will the difference be?

The current MRCGP has four modular elements:

•Multiple choice paper (MCP)

•Written paper (WP)

•Video or simulated surgery

•Orals

The new assessment process (nMRCGP) will consist of three elements:

•Applied knowledge test (AKT)

•Clinical skills assessment (CSA)

•Workplace-based assessment (WPBA)

For the first time in the history of national GP assessment, there will be a comprehensive test of clinical competence. All the new assessment elements will be piloted. As with the current MRCGP, there will be costs associated with the nMRCGP, the scale of which have not yet been determined.

New training programmes

The key features of the proposed new three-year schemes from 2007 or before are: that they will be competency based; have educational supervision from general practice even for hospital placements; offer a series of short – for example four-month – attachments in settings outside of general practice, and finally, but most importantly, contain an aspiration for a minimum of 18 months' training in a GP practice.

It is proposed the final date for acceptance of application to the current MRCGP should be 2 February 2007. After that, registrars will be required to complete nMRCGP.

Registration and certification

The RCGP worked closely with the former JCPTGP and the Postgraduate Medical Education and Training Board to ensure a smooth transition when the PMETB assumed its statutory powers on 30 September, when the JCPTGP ceased to exist. The RCGP has set up a certification unit to process applications.

The RCGP website contains details of applications under article 5 and article 11 (certification of equivalent experience). Fees are chargeable for these applications and details are shown on the RCGP (www.rcgp. org.uk) and PMETB (www.pmetb.org.uk/ pmetb) websites. Applications will cost £350 for a CCT under article 5 arrangements. There will also be a fee payable to PMETB of £250 for the submission of CCT applications to the board. All doctors in GP training will be required to register with the RCGP.

Conclusions

A number of key improvements are taking place in GP training. Registrars need to know the timetable for change. Reform of training should not be seen as an end in itself. Its ultimate goal must be to improve patient care by better training of doctors.

From the new training we should expect more patient-centred GPs, solid all-round generalists with a higher level of knowledge and skills, and GPs better prepared to meet patients' needs.

Improvements

• A two-year foundation programme followed by explicit national selection for GP training

• A first-ever national GP curriculum to define the content of training

• Vocational training replaced by competency-based specialist training programme

• Single new assessment programme (the new MRCGP) to confirm exit from training and enter the profession as an independent GP

Key features

• Applied knowledge test

• About 200 machine markable multiple choice-type questions

• Clinical skills assessment

• A multi-station objectively structured clinical examination (OSCE)

• Workplace-based assessment (WPBA)

• An enhanced training record including a number of externally moderated assessment tools to monitor the progress of the registrar

Take-home points

• A new competency-based specialist

training programme from 2007

• A new standard for entering the profession from 2007 with a single assessment process for CCT – the standard will be the MRCGP examination of the college

• GMC establishes generalist register 2006

• Registrars must now register with the RCGP for certification and get free

associate membership

• The new MRCGP will consist of an applied knowledge test, clinical skills assessment and workplace assessment

• Transitional arrangements apply from 2005 to 2007

Mayur Lakhani is RCGP chair

This work is being carried out by a college team led by Dr Val Wass and

Dr Colin Hunter

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