The nMRCGP
The nMRCGP commenced on 1st August 2007 effectively combining the separate Summative Assessment (SA) and traditional MRCGP examinations. This is the licensing system for all UK trained doctors wishing to obtain a Certificate of Completion of Training (CCT) in General Practice and gain entry to the GMC’s GP register.
The whole of the nMRCGP is mapped to competency areas derived from the RCGP GP Curriculum.
Since no one method of assessment can be completely satisfactory, the nMRCGP is an integrated triangulation of assessments. These will each assess separate areas although there will be some degree of natural overlap. Several new elements have been introduced compared to the old MRCGP and SA exams.
The Applied Knowledge Test (AKT)
The Clinical Skills Assessment (CSA)
The Work Place Based Assessment (WPBA)
Electronic Portfolio (ePortfolio)
The Applied Knowledge Test (AKT)
The AKT tests the application of clinical knowledge. It remains similar to the multiple choice paper of the MRCGP. The change is to do with the process of sitting the AKT, rather than with its content. Candidates will take a computer-based AKT at allocated centres around the country. Candidates are encouraged to register early to get their preferred test centre. More detail on the applied knowledge test.
The Clinical Skills Assessment (CSA)
The clinical skills assessment (CSA) assesses the integration of application of clinical, professional, communication and practical skills. The CSA Component is distinctly different from previous MRCGP modules. Assessors will observe candidates consulting with standardised patients, all played by professional actors. The venue for this simulated surgery will be in Croydon. More detail on the clinical skills assessment.
Work Place Based Assessment (WPBA)
WPBA is defined as "the evaluation of a doctor’s progress over time in their performance in those areas of professional practice best tested in the workplace”. Its aim is to try and link teaching, learning and assessment. More Detail on the Workplace-based Assessment.
Each defined area of competency should be demonstrated when the learner is ready to do so and it is anticipated that there will be a development of skills and progression in each competency over the whole 3 years duration of WPBA.
For each competency, the trainee will be assessed and graded as “showing insufficient evidence” or progressing to “needs further development” or a passing “competent” but could still develop further to an “Excellent”.
The assessors are locally based with individual Clinical Supervisors (Hospital Consultant or GP Trainer) and a 6 monthly Educational Supervisor review.
Evidence will be gathered about the learners’ development using a variety of methods including;
Case Based discussion (CBD) – effectively a structured oral interview designed to assess professional judgment.
Consultation Observation Tool (COT) – this can be either direct observation of a doctor consulting or by using the familiar tool of video.
Clinical Evaluation Exercise (Mini-CEX) – this is a 15 minute snapshot of a doctor/patient interaction formally assessed with immediate 5 minute feedback. This effectively is the secondary care based equivalent of a COT.
Direct Observation of Procedural Skills (DOPS) – a 20 minute formal assessment of procedural skills essential to the provision of good clinical care. In General Practice the relevant technical skills might include cervical smears, breast examination, vaginal and rectal examination and minor surgical skills. If these have not been demonstrated early on in the ST1 & ST2 years, it will be necessary to do so in the final Registrar year.
Apart from the above local assessment tools, there will be external tools too;
Multi-Source Feedback (MSF) – web based feedback assessing clinical ability and professional behaviour. Feedback will be from at least 5 clinical and 5 non-clinical staff on four separate occasions - twice in ST1 & ST2 year 1 (ST1) and twice in ST3.
Patient Satisfaction Questionnaire (PSQ) – 30 consecutive consultations will need formal written patient feedback in particular looking at consultation skills and empathy scores.
