The new MRCGP–what's it all about?
GP at the Fern Hill Practice, Faringdon, and RCGP Curriculum Development Fellow
E-mail: ben.riley{at}nhs.net
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What is the new MRCGP? |
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 TOP What is the new... Why were the old...Who is responsible for...How does the RCGP...What role does my...Useful resources for getting...Notes |
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The new Membership of the Royal College of General Practitioners assessment (new MRCGP) is the new compulsory assessment for all doctors wishing to become General Practitioners in the UK. The new MRCGP is made up of three main assessments:1.
- 1. Applied Knowledge Test
The MCQ-style paper
- 2. Clinical Skills Assessment
The OSCE-style assessment of GP skills
- 3. Workplace-Based Assessment (WPBA)
A continuous assessment based on your e-Portfolio and trainer's report
- 2. Clinical Skills Assessment
These three assessments are designed to assess GPs in training against 12 new MRCGP competency areas (see Figure 1).
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Why were the old exams changed? |
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Until autumn 2007, there was a choice of two quite different routes for a doctor wanting to become a qualified GP. The easiest route was Summative Assessment, which usually involved completing a MCQ exam, an audit, a video of consultations, and a trainer's report. The other route was the old MRCGP exam, which involved two exam papers, an oral exam, and a more stringently marked video. The MRCGP exam began in 1965 and has been compulsory for GPs seeking entry into membership of the College since 1968. Although the RCGP has argued that the MRCGP should be the compulsory assessment for all GPs for many years, the fail-rate of the old exam, intended to be ‘a test of excellence’ rather than of minimal competence, was politically unacceptable at over 25%.1
In September 1996, Summative Assessment was introduced for all GP Registrars completing their training. This was the first introduction of a national assessment package for general practice and its key function was to protect patients from harm by weeding out any incompetent doctors. There is published evidence that Summative Assessment identified a number of doctors whose incompetence could otherwise have passed undetected.2
Over time, as more GP trainees opted to take the MRCGP exam, the two assessments grew closer together, resulting in a single route for submitting videotaped consultations. It became an increasingly widely held belief that Summative Assessment, meant to be a test of minimal competence, was a fairly derisory exam.3 Many in the profession began to feel it was unacceptable in the 21st century for a doctor to be allowed to work as a GP without ever having attempted to pass a professional standard exam, or to be allowed to join the GP register despite having failed it.
Since September 2007, the Summative Assessment and old MRCGP exams have been replaced by the mandatory, single ‘new MRCGP’ assessment. The new MRCGP is an assessment of professional competency and is based on a modern educational theory and evidence-based approach to assessment (see Figure 2).
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Who is responsible for the new MRCGP assessments? |
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The new MRCGP assessments are set and administered by the Royal College of General Practitioners (RCGP). The RCGP is the national academic organisation of general practitioners in the UK. Its role is to encourage and maintain the highest standards of general practice and act as the ‘voice’ of GPs on professional issues such as education, training, and standards of care for patients. Under the terms of its Royal Charter, the RCGP does not deal with work-related issues such as pay, tax, or the terms and conditions of service (the British Medical Association is the appropriate body for these issues). The RCGP is a non-profit making organisation and a registered charity (no. 223106).
The Postgraduate Medical Education and Training Board (PMETB) is a non-governmental, independent regulatory body, which is responsible for approving the GP training curriculum and the nMRCGP assessments. PMETB is also in charge of approving all the training posts that lead to the award of the Certificate of Completion of Training (CCT), and for certifying doctors on the national GP register.
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How does the RCGP curriculum relate to the new MRCGP? |
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The RCGP curriculum describes the core knowledge, skills, and attitudes required to be a competent GP. More than that, it explains the rationale, philosophy, and scientific basis for why these are important, and broadly sets out how these attributes should be developed.
The new MRCGP is an assessment of twelve areas of competency based on the curriculum. These competencies are intended to encapsulate the key aspects of general practice that can be assessed reliably, but it is important to realise that on their own they do not represent the whole of general practice. This is because there are many aspects to being a successful GP that cannot easily be measured in a reliable way under exam conditions (such as the doctor's ability to convey empathy).
The relationship between the curriculum domains and the 12 new MRCGP competency areas is shown in Figure 3.
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What role does my GP trainer play in the new MRCGP assessments? |
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Modern GP Specialty Training involves a large number of important responsibilities for your trainer. Not only must your trainer support your educational progress throughout the three-year programme, he or she is also responsible for regularly monitoring your progress and undertaking a range of reviews and assessments as part of Work-Place Based Assessment.
The relationship between yourself, as a learner, and your trainer, as mentor, is central to the success of your training and education. It is essential to meet with your trainer at regular intervals throughout the three-years of the training programme, even when based in hospital, to complete the reviews required for Work-Place Based Assessment and to identify and address and any learning or training needs.
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Useful resources for getting to grips with the curriculum and the new MRCGP |
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Notes |
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TOPWhat is the new...Why were the old...Who is responsible for...How does the RCGP...What role does my...Useful resources for getting...Notes |
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1 Haslam, D. Why did the examination need to change? In: Moore, R. The MRCGP examination: a guide for candidates and teachers. RCGP, London 1998.
2 Campbell, L.M., Murray, T.S. Summative assessment of vocational trainees: results of a three-year study. British Journal of General Practice 1996; 46: 411–4.
3 Field, S.J., Skelton, J.R. The first year of summative assessment in the West Midlands Deanery: a questionnaire survey of the views of trainers and course organisers. Education for General Practice 1998; 9: 422–9.
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