Tips from Dr Amit Chauhan, who has just passed the new RCA component of the MRCGP
The RCGP has rolled out the recorded consultations assessment (RCA) as the third component of the MRCGP in place of the clinical skills assessment (CSA). Understandably, this has caused anxiety among trainees and trainers. Here are some tips that helped me through.
1 Know the rules
Read these documents on the RCA section of the RCGP website1 to help you understand the new format: the RCA candidate handbook, assessment policy, case guidance and frequently asked questions. The RCA grade descriptors and domain marking are also helpful.
FourteenFish2, a company offering an appraisal toolkit, has produced a helpful video, available on its platform, the candidate dashboard and YouTube.
2 Ensure you get patient consent
There are many ways to conduct your consultation and that’s the beauty of general practice. But for the purpose of the exam, there are a few essential things, for example, consent. Patient consent is a must for any recording. If you’re using FourteenFish, the service automatically asks the patient for consent as part of the pre-consultation. But if you’re recording with webcams or other platforms, consent needs to be sought at the start of the recording. Written consent in the description of the case submitted is also acceptable. Your trainer will need to authenticate all consultations before upload and so you must show them the consent.
3 The RCA is the CSA’s baby
Example scenarios from CSA websites and books will help you understand the type of cases expected for the RCA, as the marking descriptors remain the same. The college advises that candidates should demonstrate their skills from:
• Across the curriculum, with no more than two cases from one clinical area.
• A spread of ages (including where possible a child and an elderly patient).
• A case involving a mental health concern.
• A case with a long-term condition, for instance, cancer, multimorbidity or a disability.
• A case related to urgent or unscheduled care.
4 Aim for a complete consultation
The RCGP advises that you use new patient contacts in your video rather than follow-ups as doing so is more likely to allow you to demonstrate competence. So try to submit cases that highlight first contact for a specific symptom. It helps to submit a full consultation with all the history, appropriately feasible examination and sometimes further options, which include an appointment for an examination. Simple triage consultations are unlikely to be suitable.
5 Communication is the key
Speak to the receptionists, nurses and GPs about your requirements. Colleagues will have tons of suggestions to make your life easier. Speak to the person who deals with all the e-consultations coming to your practice and look out for the ‘juicy’ ones.
6 Record many consultations
You will be amazed by how many good consultations emerge if you choose to record each one. Even with sick notes, you may cover psychosocial issues and health promotion. Many patients are presenting with pandemic anxiety, so physical and psychological manifestations of these can be appropriate. Recording more cases will let you choose from a wide variety and helps boost your confidence.
7 It’s an exit exam
The RCGP expects that cases should allow an ST3 trainee to demonstrate safe and independent practice. So give them what they want to see. Avoid consultations you think could have been done in five minutes if you hadn’t followed the formula. Go for consultations that are complex and demonstrate your competence in three domains rather than complex patients with many comorbid conditions.
8 Be ruthless
It is all about you. If you think in the first few minutes that a consultation is not going that well, don’t include it. Look at all the booked appointment slots, identify suitable patients and ask colleagues if you can see them. If possible prepare for them.
9 It’s not just your exam
The CSA was a trainees’ exam but the RCA is a test of the trainer and the whole practice. You need all of the wider team to help you get your case mix – for example, diabetic and respiratory clinic nurses, the other registrar and the midwife.
10 It’s a journey
Unlike the CSA, the RCA is not a one-day game. So, every day is like an exam until you submit. You need to eat healthy, sleep well and stay focused.
Dr Amit Chauhan is a GP in County Durham
1 RCGP: MRCGP: Recorded Consultation Assessment. tinyurl.com/RCGP-RCA
2 Fourteenfish RCA support page. tinyurl.com/14fish-RCA