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nMRCGP – A potted guide by Bill
August 2008
It is all on the RCGP Website
http://www.rcgp-
curriculum.org.uk/examinations_and_assessment.as
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Look for the PowerPoint on each section….
Enjoy the CSA Virtual tour!
This is a potted version!
The RCGP Website may be
more up to date
Groups within the nMRCGP assessment
process
Applied Knowledge Test
Timed multiple choice question paper, written or computer
based. Good test of knowledge.
Clinical Skills Assessment
Clinical consulting skills examination, based on cases from
general practice, with role players as „patients‟, and experienced
MRCGP assessors. This assessment is able to provide a
pre-determined, standardised level of challenge to candidates.
Workplace Based Assessment
Portfolio based, with formative and summative assessment,
variety of testing formats. Able to test doctor in his/her place of
work, doing what he/she actually does. Some external validation
included.
nMRCGP
The Applied Knowledge Test :
The content of the assessment will be based on
curricula for postgraduate training which
themselves are referenced to all of the areas of
Good Medical Practice
The MRCGP Curriculum
Statements
Where to find them
RCGP website
http://www.rcgp-curriculum.org.uk/
What are they?
Series of papers, each covering different
clinical and practice management areas,
based on European Academy of
Teachers in General Practice (EURACT)
framework.
The MRCGP Curriculum
Statements
How they are being used
Curriculum statements subdivided into „Intended learning
outcomes‟. Cases linked to specified learning outcomes within
specified curriculum statements.
This enables sampling from across the curriculum, as cases can
be mapped to the curriculum statements (or nMRCGP blueprint)
The AKT:
The Applied Knowledge Test (AKT) is a
summative assessment of the knowledge base
that underpins independent general practice
within the United Kingdom.
Candidates who pass this assessment will have
demonstrated their competence in applying
knowledge at a level which is sufficiently high for
independent practice.
Format:
A three hour, 200 item multiple-choice
test
Delivered on a computer terminal at an
invigilated test centre
Offered initially three times a year
Dates
Offered three times a year:
29th October 2008
28th January 2009
29th April 2009
28th October 2009
Rules
No limit to the number of attempts
(£378 each time!)
A pass will be valid for three years only
Can be attempted at any time during GP
specialist training (GPST), but most
appropriately during the GPR year (ST3)
(best take it after first 3 months as ST3)
Will test the application of knowledge
Avoidance of unnecessary “low level” factual
questions
Question types selected from Bloom‟s
taxonomy:
Comprehension, application, analysis,
synthesis
Emphasis on the application of knowledge to
real-life general practice situations
Breakdown by subject
Core clinical medicine and its application to problem
solving in a general practice context:
80% of items
Critical appraisal and evidence-based clinical practice
10% of items
Health informatics and the organisational structures
that support UK general practice
10% of items
Item Formats
Single Best Answer (SBA)
Extended Matching (EMQ)
Tables and Algorithms (for completion)
Photographs
Computer Based Testing
Security at each centre
will be robust
Identity checks
Invigilated
Video monitoring
Computer Based Testing
Test forms are
downloaded to each centre
each day
Separate morning and
afternoon sittings
Responses will be
uploaded to a central
server and then passed to
the RCGP for post test
analysis
Following this, results and
feedback will be sent
individually to candidates
Computer Based Testing
There are 147 test centres
Candidates registered with the
RCGP will be able to book the AKT
at a local venue, on “a first come,
first served” basis
nMRCGP
The Clinical Skill Assessment
(CSA)
Why a Clinical Skills Assessment?
Old MRCGP had no clinical consulting skills
component
Provides external validation / triangulation with
the other testing methods used
Using simulated patients is a validated and
reliable method for testing clinical skills
Able to offer a standardised, pre-determined
level of challenge to candidates and to vary this
level of challenge
Purpose of the CSA :
„An assessment of a doctor‟s ability to
integrate and apply appropriate
clinical, professional, communication
and practical skills in general practice‟
CSA Blueprint derived
from the Curriculum
Blueprint area Descriptor
Data gathering and Gathering of data for clinical judgement, choice of examination,
interpretation investigations and their interpretations
Recognition and management of common medical conditions in primary
Management
care. Demonstrates flexible and structured approach to decision making
Co-morbidity & health Demonstrating ability to deal with multiple complaints and
promotion co-morbidity and to promote positive approach to health
Use of recognised communication techniques that enhance
Person-centred
understanding of a patient‟s illness and promote a shared approach to
approach
managing problems
Practising ethically with respect for equality and diversity in line with
Professional attitude
accepted codes of professional conduct
Demonstrating proficiency in performing physical examinations and using
Technical skills
diagnostic and therapeutic instruments
Case Selection Blueprint
Clinical Skills Assessment
Primary nature of case
Case Selection Blueprint
Primary system or area of disease Undiffere
Acute Chronic Psychol and Preventive
ntiated Other
Illness Illness Social /lifestyle
Illness
Cardiovascular
Respiratory
Neurological/ Psychiatric
Musculo-skeletal
Endocrine/ Oncological
Eye/ ENT/ Skin
Men/ Women/ Sexual Health
Renal/ urological
Gastro-intestinal
Infectious diseases
ETC
What is the CSA likely to look like?
Temporary assessment centre in Croydon
Dedicated assessment centre within new
College build over the next 3-5 years
For a number of weeks, several times a year
Will use multiple circuits
Candidate stays in „surgery‟ and patient and
examiner move around circuit
What is the CSA likely to look like?
Will consist mostly of simulated patient
cases.
13 stations, each of 10 minutes
The Marking Schedule
Each case is marked in 3 domains :
Data gathering, examination and
clinical assessment skills
Clinical management skills
Interpersonal skills
All domains have equal weighting
Four possible Grades
Clear Pass (CP)
Marginal Pass
(MP)
Marginal Fail (MF)
Clear Fail (CF)
Further resources…..
CSA sample cases to be made
available soon
Latest information on RCGP website
Wessex Deanery DVD on the CSA
nMRCGP
Workplace-based assessment
“The evaluation of a doctor‟s progress
over time in their performance in those
areas of professional practice best
tested in the workplace.”
Why workplace-based assessment?
Tests something important and
different from other components
“Does do versus can do”
Reconnects assessment with learning
Has high educational impact
Valid and reliable
The WPBA framework
Integrated package
Competency-based training
record over 3 years
The competency-based training record
Competency-based
Developmental
Evidential
Locally assessed
Triangulated
What does this mean……. ?
Competency-based
12 competency areas
Best tested in the workplace setting
Developmental progression for each
competency area
Competency demonstrated “when
ready”
Process is learner led
The 12 competency areas
1. Communication and 7. Primary care administration
consulting skills and IMT
2. Practicing holistically 8. Working with colleagues and
3. Data gathering and in teams
interpretation 9. Community orientation
4. Making a diagnosis/ making 10. Maintaining performance,
decisions learning and teaching
5. Clinical management 11. Maintaining an ethical
6. Managing complexity and approach to practice
promoting health 12.Fitness to practice
Evidential
Multiple sampling
From multiple perspectives
Tool-box of “approved” methods
(locally assessed and national
complementary tools)
Sufficiency of evidence defined
Locally assessed
Assessed by clinical supervisor in hospital or
GP Trainer in general practice setting
Regular reviews at 6 month intervals by
trainer/educational supervisor
Review all the assessment information
gathered
Judge progress against competency areas
Provide developmental feedback
Triangulated
Different raters
Many tools (e.g. CBD, COT,
mini CEX, DOPS, MSF and
PSQ)
Different settings (hospital and
general practice)
Tools for Evidence
CBD (case based discussion)
COT (consultation observation tool)
mini-CEX (clinical evaluation exercise)
DOPS (direct observation of procedural
skills)
MSF (multi-source feedback)
PSQ (patient satisfaction questionnaire)
Case-based discussion
Structured oral interview
Designed to assess professional judgement
Across a range of competency areas
Starting point is the written record of cases
selected by the trainee
Will be used in general practice and hospital
settings
COT
Tool to assess consultation skills
Based on MRCGP consulting skills criteria
Can be assessed using video or direct
observation during general practice settings
(Mini CEX are used instead of COT in hospital
settings)
DOPS
For assessing relevant technical skills during
GP training:
Cervical cytology
Complex or intimate examinations
(e.g. rectal, pelvic, breast)
Minor surgical skills
Similar to F2 DOPS
MSF
Assessment of clinical ability and
professional behaviour
ST1 Rated by 5 clinical colleagues, 2
occasions ST3 Rated by 5 clinical and 5
non-clinical colleagues on 2 occasions
Simple web based tool
Is able to discriminate between doctors
Needs skill of trainer in giving feedback
PSQ
Measures consultation and relational
empathy (CARE)
30 consecutive consultations in GP setting
Central optical scanning and generation of
results
Can differentiate between doctors
Needs skill of trainer in giving feedback
Naturally occurring evidence
From direct observation during training
“tagged” against appropriate competency
headings
Other practice-based activities
Monitoring Progress
Interim reviews with trainer every 6
months
ensure the trainee is making
satisfactory progress
agree training needs
Monitoring Progress
Deanery Panel meeting at end of ST1
and ST2
reviews the training records of every
trainee
face to face review with trainees when
unsatisfactory achievement in either
of the complementary tools
or when requested by the
educational supervisor
Workplace-based assessment ST1
6 month 12 month Deanery panel
if unsatisfactory
Interim review Interim review
Based on evidence: Based on evidence:
3 x COT or mini-CEX 3 x COT or mini-CEX
3 x CBD 3 x CBD
1 x MSF 1 x MSF
1 x PSQ * 1 x PSQ *
DOPS ** DOPS ** * if GP post
Clinical supervisors‟ ** if appropriate
Clinical supervisors‟
report ** report **
Workplace-based assessment ST2
18 month 24 month Deanery panel
if unsatisfactory
Interim review Interim review
Based on evidence: Based on evidence:
3 x COT or mini-CEX 3 x COT or mini-CEX
3 x CBD 3 x CBD
1 x PSQ * 1 x PSQ *
DOPS ** DOPS **
* if GP post
Clinical Clinical supervisors‟ ** if appropriate
supervisors‟ report ** report **
Workplace-based assessment ST3
Deanery sign off or
30 month 34 month panel review if
unsatisfactory
Interim review Final review
Based on evidence: Based on evidence:
6 x COT 6 x COT
6 x CBD 6 x CBD
1 x MSF 1 x MSF
DOPS ** DOPS **
PSQ
** if appropriate
The final judgement
The trainer makes a recommendation as to
whether the trainee has achieved
competence in all 12 areas at the end of
training
Review by Deanery Panel
Review of e-portfolio if training record
satisfactory
Review of e-portfolio and face-to-face
meeting with trainee, if satisfactory level
not achieved
