nMRCGP Please remember the final format is not set and this presentation was in March 2007



PMETB The establishment of the Postgraduate Medical Education Training Board (PMETB) has led all royal colleges to review their curriculi and appraise their assessments against PMETB principles

At the same time, Modernising Medical Careers introduced a competency based curriculum for the foundation year programme. This highlighted the need for more flexible formative career progression which avoids tying trainees to rigid summative examinations.

changing philosophy of assessment Increased emphasis on performance in the workplace

Rational 1. Neither summative assessment nor the MRCGP exam has a robust assessment of clinical skills 2. Both focus on assessing communication skills in the consultation, not overall clinical competency 3. Two tiered system of summative assessment and the MRCGP exam was proving too cumbersome. 4. The multiple assessment hurdles impacted detrimentally on the educational agenda

The trainees asked for A robust assessment package worthy of effort An educationally focused, effectively delivered trainer's report Fair, reliable, and relevant examinations Fewer summative hurdles Developments mindful of costs.

The lay representatives asked for: Appropriate, reliable standards for completion of training Assurance registrars will be safe for independent practice Lay involvement in standard setting A clinical skills test.

The educators asked for: More time to teach Less assessment A single route process Formative approaches Flexible career progression Avoidance of multiple workplace assessment hurdles Opportunities for remedial support for any struggling trainees.

The assessors asked for Assessments which drove the education agenda Content reflective of real practice Continuing high standards for assessor selection and training Maintenance of a national panel of assessors Fairness and equal opportunities for trainees and assessors

PMETB standards require that the assessments are designed to "confirm suitability of choice at an early stage of chosen career path." A single, national UK assessment centre based selection process into vocational training is being established by the deaneries.

Standards They will be at a level appropriate to exit from vocational training that assures the public that registrars are safe and "fit for purpose" to practise independently. New standard to be set by the PMETB on the recommendation of the RCGP.

From August 2007 there will be a single training and assessment system for UK trained doctors wishing to obtain a CCT (Certificate of Completion of Training) in General Practice.

Certification unit  It is recommended that those training for General Practice register with the Certification Unit as soon as they begin the CCT programme ( £350)  The RCGP ’s Certification Unit has functional responsibility for processing applications for certification as a General Practitioner (£250)

How to become a GP  An online application  A two-part assessment involving a Multiple Choice assessment of clinical competence and a handwritten short question paper  Successful candidates are asked to attend further selection assessment  Allocation and offer  No mention re those that are not successful.

The nMRCGP is an integrated assessment programme that includes three components:  Applied Knowledge Test (AKT), Applied Knowledge Test  Clinical Skills Assessment (CSA) Clinical Skills Assessment  Workplace-Based assessment (WPBA). Workplace-Based assessment

Applied Knowledge Test  The applied knowledge test is a summative assessment of the knowledge base that underpins independent general practice within the united kingdom.  The test will take the form of a three hour 200 item multiple-choice test  The AKT will be delivered using computer terminals at 147 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 10% on health informatics and administrative issues.

On three days each year candidates will be able to sit the AKT at one of the Pearson Vue centres.

Candidates registered for the nMRCGP will call Pearson Vue to book a test and choose a centre. The earlier a candidate books, the greater the chances of their preferred centre being available:

Clinical Skills Assessment The Clinical Skills Assessment (CSA) is‘an assessment of a doctor’s ability to integrate and apply clinical, professional, communication and practical skills appropriate for general practice’.

This component of the nMRCGP will be available from October The assessment will be available during a 3 or 4 week period in sessions in February, May and October each year. It will take place in one location

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 - Clear Pass, Marginal Pass, Marginal Fail Clear Fail.

Example scenarios showing the nature of this assessment nMRCGP - A guide to the Clinical Skills Assessment DVD Wessex Faculty RCGP

The CSA will test mainly from the following areas of the curriculum: 1. Data gathering, technical and assessment skills 2. Clinical management skills 3. Interpersonal skills

Workplace-based Assessment  WPBA for nMRCGP is defined as the evaluation of a doctor’s progress in their performance over time, in those areas of professional practice best tested in the workplace.  Longitudinal process

Twelve areas of professional competence have been extracted from the core curriculum statement ‘Being a General Practitioner’.

*Communication and Consultation Skills *Practising Holistically *Data Gathering and Interpretation *Making a Diagnosis/Making Decisions *Clinical Management *Managing Medical Complexity

 Primary Care Administration and Information Management and Technology  Working with Colleagues and in Teams  Community Orientation Maintaining Performance, Learning and Teaching  Maintaining an Ethical Approach to Practise  Fitness to Practise

Deanery  Will moderate the GP trainers.  Will review all evidence  Will collate externally moderated assessments.

The e-Portfolio The evidence for WPBA will be recorded in a web-based e-portfolio. The e-portfolio is much more than an electronic record of specialist training, updated and accessible through the internet, it records details of achievement in the Applied Knowledge Test and Clinical Skills Assessment, and documents all stages of training, records evidence of WPBA, `reviews with educational supervisors and the subsequent development as a General PractitionerApplied Knowledge TestClinical Skills Assessment

Learning Log Log Entries Clinical encounters, tutorials, reading, lectures, seminars, professional conversations and more. Personal Development Plan A dynamic record of training needs

Assessments Progress to Certification Information on CCT, chart summarizing progress, declarations and more. Applied Knowledge Test (AKT) Information on AKT, how to book a test and record of result.AKT Clinical Skills Assessment (CSA) Information on CSA, online application and record of result.CSA

Workplace-based Assessment (WPBA) Information on WPBA, professional competencies, DOPS, CBD, MSF, PSQ, CSR, mini-CEX, COT.WPBACBD CSRCOT

Is it me? WPBA (Workplace based assessment) AKT (Applied Knowledge Test)  DOP (Direct obs. of procedure)  PAT (Peer assessment tool)  MSF (Multi-sourced feedback)  PSQ (Patient satisfaction questionnaire)  TAB (Team assessment of behaviour)  Mini CEX (Clinical evaluation exercise)  CBD (Case based discussion)

Or is it me?  COT  CSA (Clinical skills assessment)  CSR  CCT