NMRCGP Exam

1. nMRCGP Exam Dr Roger Tisi Dr Sunil Gupta 14th March 2007

2. nMRCGP Starts August 2007. Need to pass nMRCGP to be on GMC’s Register of GPs and for Membership of the Royal College of General Practitioners.  Information for this presentation taken from RCGP website.

3. nMRCGP Integrated assessment programme that includes three components: Applied Knowledge Test (AKT). Clinical Skills Assessment (CSA). Workplace-Based Assessment (WPBA).

4. 3 components of the nMRCGP Each independent and will test different skills. Together they will cover the curriculum for specialty training for general practice. Evidence for the workplace-based assessment will be collected in the e-Portfolio of each GP trainee. Doctors who are currently in GP training are subject to transition arrangements.

5. Applied Knowledge Test Three hour test. 200 item multiple-choice test. Question formats will be the same as for the current MCP.

6. Applied Knowledge Test Delivered using computer terminals at 147 Pearson Vue professional testing centres around the UK. Sit on a computer work station, using a mouse and keyboard to select answers. 

7. Applied Knowledge Test Need to be able to apply knowledge at a level which is sufficiently high for independent practice. All questions will address important issues relating to UK general practice. Questions focus mainly on higher order problem solving rather than just the simple recall of basic facts.

8. Applied Knowledge Test 80% of question items will be on clinical medicine. 10% on critical appraisal and evidence based clinical practice. 10% on health informatics and administrative issues. 

9. Applied Knowledge Test On three days each year candidates will be able to sit the AKT at one of the centres.  The First AKT will be held on 31st Oct 2007. Candidates registered for nMRCGP call Pearson Vue to book a test and choose a centre.  The earlier a candidate books, the greater the chances of getting their preferred centre. Pearson Vue will confirm booking by e-mail.

10. Applied Knowledge Test Eligible to attempt the AKT at any point during their time in GP specialty training. Highest chance of success, will probably be whilst working as a GP trainee in ST3.

11. nMRCGP Applied Knowledge Test (AKT). Clinical Skills Assessment (CSA). Workplace-Based Assessment (WPBA).

12. Clinical Skills Assessment ‘An assessment of a doctor’s ability to integrate and apply clinical, professional, communication and practical skills appropriate for general practice.’

13. Clinical Skills Assessment Available during a 3 or 4 week period in sessions in February, May and October each year. First time is October 2007. It will take place in one location, initially in Croydon, and in later years in a purpose-built centre in London.

14. Clinical Skills Assessment Each candidate will be given a consulting room and will have appointments with 13 patients, each lasting around 10 minutes. The performance will be graded as either: - Clear Pass - Marginal Pass - Marginal Fail - Clear Fail.

15. Areas mainly tested by CSA Primary Care Management. Problem Solving Skills. Comprehensive Approach. Person-centred Care. Attitudinal Aspects. Clinical Practical Skills.

16. Areas mainly tested by CSA 1. Primary Care Management - recognition and management of common medical conditions in primary care. 2. Problem Solving Skills - gathering and using data for clinical judgement, choice of examination, investigations and their interpretation. Demonstration of a structured and flexible approach to decision making.

17. Areas mainly tested by CSA 3. Comprehensive Approach - demonstration of proficiency in the management of co-morbidity and risk. 4. Person-centred Care - communication with patient and the use of recognised consultation techniques to promote a shared approach to managing problems.

18. Areas mainly tested by CSA 5. Attitudinal Aspects - practising ethically with respect for equality and diversity, with accepted professional codes of conduct. 6. Clinical Practical Skills - demonstrating proficiency in performing physical examinations and using diagnostic/therapeutic instruments.

19. CSA marking Each case given grade for each of three Domains: 1. DATA-GATHERING, TECHNICAL & ASSESSMENT SKILLS. 2. CLINICAL MANAGEMENT SKILLS. 3. INTERPERSONAL SKILLS.

20. DATA-GATHERING, TECHNICAL & ASSESSMENT SKILLS Gathering & using data for clinical judgement, choice of examination, investigations & their interpretation. Demonstrating proficiency in performing physical examinations & using diagnostic and therapeutic instruments. (Blueprint: Problem-solving skills, Technical Skills)

21. CLINICAL MANAGEMENT SKILLS Recognition & management of common medical conditions in primary care. Demonstrating a structured & flexible approach to decision-making. Demonstrating the ability to deal with multiple complaints and co-morbidity. Demonstrating the ability to promote a positive approach to health. (Blueprint: Primary Care Management, Comprehensive approach)

22. INTERPERSONAL SKILLS Demonstrating the use of recognised communication techniques to understand the patient’s illness experience and develop a shared approach to managing problems. Practising ethically with respect for equality and diversity, in line with the accepted codes of professional conduct. (Blueprint: Person-centred approach, Attitudinal aspects).

23. Clinical Skills Assessment Examples of CSA cases on DVD.

24. Tea break

25. nMRCGP Applied Knowledge Test (AKT). Clinical Skills Assessment (CSA). Workplace-Based Assessment (WPBA).

26. Workplace-based Assessment in the nMRCGP ‘The evaluation of a doctor’s progress in their performance over time, in those areas of professional practice best tested in the workplace.’

27. Why have a workplace based assessment Provides an opportunity for the assessment to get as close as possible to the real situations in which doctors work. Some competency areas e.g. professional development, probity, team-working simply cannot be assessed effectively in any other way. Ensures Assessment is an integral part of educational planning.

28. Workplace-based Assessment will Provide feedback on areas of strength and development needs. Identify trainees in difficulty. Drive learning in important areas of competency. Determine fitness to progress to the next stage of the trainee’s career.

29. Workplace-based Assessment Addresses the majority of the curriculum, assessing those parts that are best tested in the workplace.  Twelve areas of professional competence have been extracted from the core curriculum statement ‘Being a General Practitioner’.

30. Twelve areas of professional competence assessed in WPBA 1) Communication and Consultation Skills- communication with patients and the use of recognised consultation techniques. 2) Practising Holistically- the ability to operate in physical, psychological, socio-economic and cultural dimensions, taking into account feelings as well as thoughts. 3) Data Gathering and Interpretation- gathering and use of data for clinical judgement, the choice of examination and investigations, and their interpretation.

31. Twelve areas of professional competence assessed in WPBA 4)Making a Diagnosis/Making Decisions- a conscious, structured approach to decision-making. 5)Clinical Management- the recognition and management of common medical conditions. 6)Managing Medical Complexity- aspects of care beyond managing straightforward problems, including the management of co-morbidity, uncertainty and risk, and the approach to health rather than just illness.

32. Twelve areas of professional competence assessed in WPBA 7)Primary Care Administration and Information Management and Technology - the appropriate use of primary care administration systems, effective record keeping and information technology for the benefit of patient care. 8)Working with Colleagues and in Teams - working effectively with other professionals to ensure patient care, including the sharing of information with colleagues. 9)Community Orientation- the management of the health and social care of the practice population and local community.

33. Twelve areas of professional competence assessed in WPBA 10) Maintaining Performance, Learning and Teaching - maintaining the performance and effective continuing professional development of oneself and others. 11) Maintaining an Ethical Approach to Practise - practising ethically with integrity and respect for diversity. 12) Fitness to Practise - the doctor’s awareness of how their own performance, conduct or health, or that of others, might put patients at risk and the action taken to protect patients.

34. Collecting Evidence for WPBA Case-based Discussion (CBD). Consultation Observation (COT) or Mini-CEX. Direct Observation of Procedural Skills (DOPS). Evidence recorded through direct observation or Clinical Supervisors’ Reports (CSR). Multi-Source Feedback (MSF). Patient Satisfaction Questionnaire (PSQ).

35. Case based discussion (CBD) 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. 6 in ST1, 6 in ST2 and 12 in ST3.

36. Consultation Observation (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 used instead of COT in hospital settings. 6 in ST1, 6 in ST2 and 12 in ST3.

37. Direct Observation of Procedural Skills (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.

38. Multi-Source Feedback (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. BUT Needs skill of trainer in giving feedback.

39. Patient Satisfaction Questionnaire (PSQ) Measures consultation and relational empathy (CARE). 25 consecutive consultations in GP setting. Central optical scanning and generation of results. Can differentiate between doctors. BUT Needs skill of trainer in giving feedback.

40. Quantity of evidence required The following description given applies only to those Drs starting a three-year programme on 1 Aug 2007. Trainees who have two years of training to complete from 1 Aug 2007, will begin WPBA from the heading Specialty Training Year 2 onwards. Trainees who have one year of training to complete from 1 Aug 2007, will begin WPBA from the heading Specialty Training Year 3 onwards. Doctors who have completed hospital and/or GPR posts prior to 1 Aug 2007, will be asked to produce the usual VTR/2 and/or VTR/1 forms for these posts.

41. Required Evidence from Specialty Training Year 1 Prior to 6 month (6m) review • 3 x COT or mini-CEX• 3 x CBD• 1 x MSF, 5 clinicians only• DOPS, if in secondary care• Clinical supervisors’ reports, if in secondary care Prior to 12 m review • 3 x COT or mini-CEX• 3 x CBD• 1 x MSF, 5 clinicians only• 1 x PSQ, if in primary care• DOPS, if in secondary care• Clinical supervisors’ reports, if in secondary care

42. Required Evidence from Specialty Training Year 2 Prior to 18 m review • 3 x COT or mini-CEX• 3 x CBD• PSQ, if not completed in ST1• DOPS, if in secondary care• Clinical supervisors’ reports, if in secondary care Prior to 24 m review (primary care)• 3 x COT• 3 x CBD• PSQ, if not completed in ST1  

43. Required Evidence from Specialty Training Year 3 (primary care) Prior to 30m review• 6 x CBD• 6x COT• 1 x MSF Prior to 34m review• 6 x CBD• 6 x COT• 1 x MSF• 1 x PSQ

44. Required evidence Throughout the training mini-CEX and COT assessments will be used interchangeably. The former being adopted in the secondary care setting, the latter in primary care. DOPS assessment will only need to be carried out until the mandatory practical skills have been assessed as satisfactory. Patient satisfaction will only be assessed in the primary care setting. Multi-source feedback will involve clinical raters only when in secondary care and both clinical and non-clinical raters when in primary care.

45. Assessment of evidence Evidence will be assessed by the trainer or educational supervisor and will contribute to the e-Portfolio. E-Portfolio will be used, in its totality, to support judgments made at the interim and final reviews. 

46. Training record of WPBA Every six months, the GP trainee will meet with their trainer or educational supervisor to complete an interim review of progress.  Evidence collected is reviewed, a self-assessment conducted and the trainee’s progress judged by the trainer in each of the twelve competency areas.  Towards the end of training, a final review is conducted, this time without the trainee’s self-assessment.   

47. Judgement of WPBA Successful completion requires achievement in each of the twelve competency areas. The trainer makes a recommendation to the deanery regarding the competence of the trainee.  A failure to reach the standard will trigger a review by an expert deanery panel, which will make decisions and recommendations as to whether the workplace-based assessment has been completed satisfactorily.

48. Professional CompetenciesGrades (I) Insufficient evidence. (N) Needs further development. (C) Competent. (E) Excellent.

49. Professional CompetenciesGrades (I) Insufficient evidenceFrom the available evidence, the doctor’s performance cannot be placed on a higher point of this developmental scale. (N) Needs further developmentRigid adherence to taught rules or plans.  Superficial grasp of unconnected facts.  Unable to apply knowledge.  Little situational perception or discretionary judgement.

50. Professional CompetenciesGrades (C) CompetentAccesses and applies coherent and appropriate chunks of knowledge.  Able to see actions in terms of longer-term goals. Demonstrates conscious and deliberate planning with increased level of efficiency.  Copes with crowdedness and able to prioritise. (E) ExcellentIntuitive and holistic grasp of situations.  No longer relies on rules or maxims.  Identifies underlying principles and patterns to define and solve problems.  Relates recalled information to the goals of the present situation and is aware of the conditions for application of that knowledge.

51. The e-Portfolio Updated and accessible through the internet. It records details of achievement in the Applied Knowledge Test and Clinical Skills Assessment. Documents all stages of training, records evidence of WPBA. Records reviews with educational supervisors and the subsequent development as a General Practitioner.

52. Further information Website of RCGP http://www.rcgp.org.uk/nmrcgp_/nmrcgp.aspx