The MRCGP is required by GP Trainees to gain Certificate of Completion of Training in General Practice (CCT). The Royal College of General Practioners website is a good resource for queries.
The MRCGP consists of:
- Work Place Based Assessment (WPBA)
- Applied Knowledge Test (AKT)
- Clinical Skills Assessment (CSA)
The GP Training curriculum is broken down into 21 Statements, which are relevant to Primary Care. Within each Curriculum Statement you can find a list of learning outcomes, which you will be expected to demonstrate competence in by the end of your training.
The Curriculum also states the 13 Professional Competences, which must be proficiently demonstrated through the WPBA.
Work Place Based Assessment (WPBA)
Work Place Based Assessment (WPBA) is a process through which evidence of competence in independent practice is gathered in a structured and systematic framework. It is recorded in the trainee’s ePortfolio.
Evidence is collected over all three years of training in the e-Portfolio and used to make a holistic, qualitative judgment about the readiness of the GP Specialist Trainee for independent practice at each educational review. WPBA is a developmental process. It will therefore provide feedback to the GP Specialist Trainee and drive learning. It will also indicate where a doctor is in difficulty. It is learner led: the GP Specialist Trainee decides which evidence to put forward for review and validation by the Educational Supervisor.
The new Audio-COT has recently been added to the ePortfolio. To view resources regarding this, please see the new Audio-COT page.
Please see the RCGP website for further details on WPBA.
The ePortfolio consists of a number of sections:
- Learning Log; where trainees can reflect on learning experiences
- Personal Development Plan; where trainees can record monthly learning needs and how these will be met
- Evidence; where clinical assessments such as Mini-CEX, CbD, CEPS, MSF and PSQ are recorded
- Review Preparation; it can be seen how many learning log entries have been linked to the Curriculum Statements and validated against Professional Competency areas. It also includes the Self-Rating which needs to be completed before the six monthly educational reviews
The Learning Log
Here you have the opportunity to reflect on the learning from various sources. Learning logs can be entered under one of several different headings:
Clinical Encounters, Professional Conversations, Tutorials, Audits/Projects, Significant Event Analysis, E-Learning, Reading, Courses/Certificates, Lectures/Seminars or Out of Hours sessions.
Each entry can be linked to one or more of the relevant Curriculum Statements and you should try to demonstrate which competence area(s) you feel that the entry provides evidence for. If your Educational Supervisor feels that you have provided adequate evidence, the entry will be ‘validated’. You need to liaise with your Educational Supervisor to ensure your entries are appropriate in terms of quality and quantity. The ST1 induction session covers writing log entries in more detail.
Half of your entries should be “Clinical Encounters”. Quality is important as is linking against curriculum statements appropriately and demonstrating competencies. You should make a minimum of 1 log entry per week in ST1, 2 per week in ST2 and 3 per week in ST3.
As your experience develops your entries will become more reflective but, for a starting point, each clinical encounter is recorded under a number of headings;
What happened? A brief synopsis of the event that triggered your learning
What did you learn? What went well or not so well and why? Reflection on how the encounter made you feel and analysis of why you felt that way - what did you do about it?
What will you do differently in future? Discussion about the impact of your learning on your future practice. Did this case confirm your current practice or will it cause you to alter your practice in future?
What further learning needs did you identify? Thoughts about the boundaries of your current competence
How and when will you address these? How can you develop your competencies and how can this be demonstrated? This can be linked to your Personal Development Plan
Personal Development Plan
Here you can record your learning goals. You should make at least 3 PDP entries per six-month post. Each PDP entry should be SMART:
S – Specific
M - Measurable
A - Achievable
R - Realistic
T – Time Based
New objectives should be added as old ones are achieved. When learning outcomes are achieved you should make a comment about how your practice has been affected and how you have achieved them, for example linking to a mini-CEx or learning log entry.
GP Trainees have found these resources useful in guiding PDP entries:
“The Condensed Curriculum Guide for GP Training and the New MRCGP” by Ben Riley, Jayne Haynes and Steve Field published by Royal College of General Practitioners (second edition, 2012)
Wessex ST1 and 2 Guide
Wessex AiT Handbook
Evidence Using the Assessment Tools
There is a required minimum amount of evidence that must be collected prior to each review. It is, however, perfectly acceptable, and indeed recommended, for more assessments to be performed in order to build up a richer picture. Evidence in each of the 13 Professional Competence areas is gathered in different settings during the three years of training.
The 13 areas of Professional Competence are:
1. Communication and consultation skills
2. Practising holistically
3. Data gathering and interpretation
4. Making a diagnosis/decision
5. Clinical management
6. Managing medical complexity and promoting health
7. Organisation, management and leadership
8. Working with colleagues and in teams
9. Community orientation
10. Maintaining performance, learning and teaching
11. Maintaining an ethical approach to practice
12. Fitness to practise
13. Clinical examination and procedural skills
Most GP Specialist Trainees will not be able to show evidence of competence at the beginning of their training, but will gradually build up evidence as training progresses. The picture of competence should become more rounded and complete as the GP Specialist Trainee moves through the training programme.
In order for the Trainer or Educational Supervisor to be in a position to monitor the progress of their GP trainee in the thirteen areas, information relating to their performance needs to be collected throughout the training period using these tools:
- Case-Based Discussion (CBD)
- Consultation Observation (COT) in primary care or Mini-CEX in secondary care
- Clinical Examination and Procedural Skills (CEPS)
- Multi-Source Feedback (MSF)
- Patient Satisfaction Questionnaire (PSQ) in primary care posts
- Clinical Supervisors Report (CSR) in secondary care posts
The minimum number of each type of assessment required is in our GPEU Southampton Handbook.
Applied Knowledge Test (AKT)
The Applied Knowledge Test 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.
Questions address important issues relating to UK general practice and focus mainly on higher order problem solving rather than just the simple recall of basic facts.
Candidates will be eligible to attempt the AKT at any point during their GP Specialty Training, after starting their ST2 year. We would recommend that the AKT should be taken during the ST2 primary care post. Exams are held in October, January and April
The AKT is a rigorous professional examination and candidates should ensure that they prepare adequately.
Format of the test
The test takes the form of a three hour and ten minute multiple-choice test of 200 items. It is computer-based and delivered at 150 Pearson VUE professional testing centres around the UK. Approximately 80% of question items will be on clinical medicine, 10% on critical appraisal and evidence-based clinical practice and 10% on health informatics and administrative issues.
Please see the RCGP website for more details. The AKT can be attempted four times.
Candidates have found the following sites useful but no responsibility is taken for their content:
Clinical Skills Assessment (CSA)
GP trainees are eligible to take the Clinical Skills Assessment (CSA) when they are within 12 months of the expected date of completing their training. The CSA is an assessment of a trainees ability to integrate and apply clinical, professional, communication and practical skills appropriate for general practice. Information about the CSA may be found on the following College webpage.
The examination takes place in a purpose-built centre at the RCGP Headquarters. Each candidate will be given a consulting room and will have appointments with 13 patients, each lasting ten minutes. Patients are played by role-players who have been trained and calibrated to perform their role in a consistent manner.
The assessment will be available in eight sessions of 6 – 12 days between October and May. The majority of candidates would be expected to take the CSA in the January/February cohort during their ST3 year.
The CSA will test mainly from the following areas of the curriculum:
Primary care management
- Recognition and management of common medical conditions in Primary Care
- Gathering and using data for clinical judgement
- Choice of examination
- Investigations and their interpretation
- Demonstration of a structured and flexible approach to decision-making
- Demonstration of proficiency in the management of co-morbidity and risk
- Communication with patients and the use of recognised consultation techniques to promote a shared approach to managing problems
- Practising ethically with respect for equality and diversity, with accepted professional codes of conduct
The CSA will also test:
Clinical practical skills
- Demonstrating proficiency in performing physical examinations and using diagnostic/therapeutic instruments
The RCGP website provides a summary of characteristics of candidates who pass and fail. Candidates who failed were noted to be likely to ‘show off’ their knowledge – this is perceived as being doctor centred. Candidates who failed were also seen to be searching for a hidden agenda.
The teaching course run sessions and study groups which will help you to prepare for the CSA. We recommend that you form your own peer learning groups to study for the CSA. Facilitated study groups to help with CSA preparation are run in Southampton each year beginning in August. These are provided outside of teaching sessions and are free for Southampton trainees.
A mock CSA is run in January each year as part of the ST3 Teaching Sessions. It will held at Southampton Football Club and consists of 4 cases. It is marked by the Programme Directors who also give written feedback
There are many other sources of help and support available to trainees. These include support from a linguist; advanced communication skills training from a professional drama coach and one-to-one support from the Programme Director team. Health Education England (Wessex) has a range of expertise available to support trainees in difficulty and this is available from the Professional Support Unit.
For more information on AKT, CSA and to read about CEPS (clinical examination and procedural skills) please refer to our GPEU Southampton Handbook.
The Richard Percival Prize is awarded each year to the ST3 who has achieved the highest combined score from their AKT and CSA, during their first attempt. This is in memory of Richard Percival, a local GP and Trainer who sadly passed away in 2013.