The MRCGP Exam: all you need to know

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The MRCGP Exam all you need to know

• Roger Neighbour
• President, RCGP
• MRCGP Convenor 1997 - 2002

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Aims and functions

• Entry to unsupervised UK practice
• RCGP standard, not Summative Assessment (minimum
  competence)
• Voluntary (at the moment!)
• Taken by about 90 of UK Registrars
• of whom gt80 pass first time
• Pass rate c. 94 after one re-sit

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Dr X, MRCGP

• A quality marker of personal achievement
• Valued by patients, PCOs and (some) defence
  organisations
• Not a registrable qualification
• Passing the exam entitles to Membership
• Only Members in good standing may use the
  letters MRCGP
• Join 24,000 colleagues (Feb 2006)

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Format

• A modular credit accumulation exam
• 4 modules 2 written, 1 oral, 1 consulting
  skills
• Take separately or in combination
• Pass all within 3 years
• Up to 3 attempts at each
• No compensation between modules
• Pre-certification in CPR defibrillation
• 310 per module (2006)

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The 4 modules

• Multiple choice paper tests pure applied
  knowledge (knows). 3 hours
• Written paper tests problem-solving, critical
  appraisal (knows how). 3½ hours
• Oral tests decision-making, professional values
  (knows how, can do). 2 x 20 minutes
• Consulting skills tests clinical communication
  (can do, does do). Video or simulated surgery

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How to pass

• Start early
• Start even earlier
• Read the exam regulations the current ones
• Read them again they apply to you
• Visit the website www.rcgp.org. uk/exam
• Add it to your favourites list
• Be a good GP, not just a good exam candidate
• If in doubt, ask but ask the College!

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On the website are

• Practical details dates, forms, venues etc
• The exam regulations
• The exam syllabus
• The new GP curriculum (2006)
• The video workbook
• 5 years of sample written papers
• Examiners comments on recent exams
• Links to all the other RCGP goodies

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The syllabus in a nutshell

• Good medical practice (as per GMC)
• Generalist skills, e.g. complexity,
  patient-centredness, managing uncertainty,
  prioritising
• Doctor-patient relationship, personalised care
• Professional values, incl. ethical, political,
  social philosophical
• Monitoring and maintaining high quality
  performance
• Keeping up to date, information management
• Working with colleagues, team work
• Organisational, managerial, financial
  regulatory aspects of practice
• Self-awareness, self-care

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In other words

• Theres nothing in the exam that isnt about
  real-life practice
• and
• Theres nothing in real-life practice that wont
  turn up in the exam

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So

• To do well in the exam, forget about the exam
  and concentrate on becoming the best doctor you
  can be.
• The examiners know a good GP when they see one,
  and they know bullshit when they see it, too.

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The written paper (Paper 1)

• Read the question carefully. Answer the question
  as asked, not the question you would have
  preferred.
• Think laterally mind map before you start.
• Answer as a doctor, not as a candidate cut out
  the jargon, the padding, the clichés the
  grapeshot.
• Give illustrative details as well as headings.

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Written paper (cont.)

• Check your answers against reality ask yourself,
  Is this what a real doctor, i.e. me or an
  examiner, would do in real life?
• Dont despise or neglect the managerial,
  financial or socio-political aspects.
• Get in the habit of discussing your daily work,
  as if it really interested you.

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The MCQ paper

• Medicine 65
• Research, epidemiology statistics 20
• Administration management 15
• Questions derived from mainstream publications
  and sources
• No negative marking

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MCQ formats

• Extended matching questions
• Single best answer
• Multiple best answer
• Table / algorithm completion
• No true/false questions

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MCQ preparation advice

• Acquire the PUNs and DENs habit.
• The BNF Oxford Handbooks are about the right
  level.
• Read review articles in the peer-referenced
  literature.
• Bone up on basic statistics.
• Pulse, GP Practitioner are not peer-referenced
  journals.
• The BMJ, Lancet BJGP are.

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The orals (general)

• 2 x 20 minutes, approx. 5 questions each.
• Test communication, professional values
  personal/professional growth in the context of
• Care of patients
• Working with colleagues
• Social role of general practice
• Doctors personal responsibilities

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The oral (advice)

• Youre an adult, and the examiners are not the
  enemy.
• Stay realistic. Say what youd really do, not
  what you think the College line is.
• Cut out the jargon and the clichés
• Get into the habit of asking Why?
• Be prepared to justify any reaction or decision.
• You and the examiners both know there arent any
  easy answers in general practice.
• Think aloud. Silence is unmarkable.

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The orals (advice, cont.)

• Youll be pushed to make a decision. Make one.
• If youre borderline, youll probably pass if
  youre patient-centred and thoughtful.
• If youre not stretched, you cant show how good
  you are.
• Know the facts, and think through your opinions,
  on the issues of the day.
• Practise with a group of challenging friends.

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Consulting skills

• Either
• Simulated surgery
• or
• The bloody video
• Probably the video and we make no apology!
• Using video as an assessment encourages people
  to use it educationally.

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The video

• Read the video workbook.
• It tells you what the examiners are looking for,
  so read the workbook.
• No really read the workbook.
• Like voting read it early and read it often.
• You are more likely to fail if your Trainer isnt
  familiar with the workbook.
• So read it both of you!

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The video (cont.)

• To live a perfect life, make yourself perfect and
  then live naturally. (Zen saying)
• To make a video that will pass the MRCGP, develop
  a patient-centred consulting style, then film
  yourself consulting naturally.

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The video (cont.)

• Do lots of video consulting right from the start.
  Get the creaky practice out of the way early.
• Demand tutorials on the consultation right from
  the start.
• Read around the subject well in advance.
  Understanding principles is better than paying
  lip-service to techniques.
• Good consulting is a frame of mind, not a circus
  trick or a piece of theatre.

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The video (cont.)

• The examiners want to see you consulting with the
  patient, not with the computer.
• Youre unlikely to demonstrate Membership-level
  performance with low challenge consultations
• nor with overly complicated ones.
• If you have to spend ages selecting and editing
  your consultations, youre probably not
  consulting effectively enough.

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Some general points

• The examiners are working GPs, not the KGB. And
  they want to pass you, honestly.
• General practice is a practical, not a
  theoretical, discipline.
• The examiners read Palmer and all the other
  books, and can tell bluff when they see it.
• Dont name drop unless youve actually read the
  stuff.
• Get to know your own blind spots, prejudices and
  assumptions.

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General points (cont.)

• What you dont write or dont say cant be
  marked.
• Preparation courses and exam crammers are poor
  substitutes for experience and curiosity.
• Form a local group to practise and revise.
• Register early with the RCGP Certification Unit
• Value your Membership of the College, and let the
  College add value to your career.

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The future

• Work in progress
• Advent of PMETB
• New licensing assessment (from August 2007)
• MMC and future of specialist training