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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
    px
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

				
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