Top tips to help your trainee prepare for the RCA: an educator's guide

13 July 2021

Learning from the first years’ experience of the RCA, the RCGP in partnership with the Committee of GP Education Directors (COGPED) have updated their top tips to support those encouraging trainees to bring their best work to the assessment.

The RCGP works with COGPED to encourage and maintain a consistent approach to GP training across the United Kingdom.

1. Start by concentrating on their consultation skills, not the exam

Encourage trainees to start reviewing their consultation skills as early as possible, so that they get into the swing of it, but initially concentrate on helping them develop their own, fluent, consultation style. Make sure they use phrases that come naturally to them in a relaxed, formal setting, and not jargonistic or formulaic phrases.

Considering the mandatory criteria for the exam should come later once those skills are embedded. Make sure they read the twin post to this one, Top tips to help you prepare for the RCA: learning from past RCAs.

2. Help with the technology

Does the trainee have everything they need to record such as:

• webcam
• all necessary tech (particularly if they are remote working)
• awareness of information governance issues of recording/storing consultations?

3. Once they are ready to take the exam, get the right cases 

Advise trainees on accessing the right sort of patients and consultations to maximise chances of getting useable consultations.

• Cases submitted should be of an appropriate level of challenge sufficient to demonstrate safe and independent practice. See the “Complicating Factors” at the end of this page.
• Encourage trainees to demonstrate their skills across a breadth of the curriculum.
• Ensure there is sufficient evidence in all three domains for the assessment.
• If they are considering tagging a case as demonstrating one of the mandatory criteria, reflect on how it demonstrates competence in that area. There is now a limit of 2 cases (4 for exam) that they can tag two per criterion
• Reception and administration staff need to be ‘on board’ and know what is happening.
• Engage reception and triage clinicians to book appropriate cases.
• Simple triage consultations are unlikely to cover all three domains.
• Problems that are new to the trainee are more likely to be suitable for submission.
• Get other clinicians on board and involved with swapping of appropriate cases.
• If individual GP surgeries offer pre-triage or electronic navigation prior to a consultation, ensure this isn’t detrimental to the consultation and use these systems to ensure appropriate case exposure.
• If possible, only book willing/consenting patients to maximise opportunity.
• Make sure patients know that the call may come from a withheld or unrecognised number.
• Be creative in how cases are identified – ask nurses for any newly diagnosed hypertensives and diabetics.
• While follow up from letters might work, tell them to beware artificially ‘Creating’ a consultation by simply recapping the history and suggested treatment options when these are already in the letter or previous referral. They need to consider what is actually ‘Added’ to the patient care by their contact with them. If a patient has considered the guidance already offered and has made a clear decision, then recapping does not add anything, and such a consultation would not provide evidence of skills.
• If a consultation contains more than one discrete clinical issue, both may be assessed if covered within the 12 minutes, although if one might detract from the other, they might consider if this is an appropriate case.
• A consultation in which clothing equivalent to the ‘swimsuit area’,is removed and can be seen on a visual recording must not be submitted for assessment.
• If a consultation is submitted, where this guidance is confirmed as having been breached, no marks will be awarded for that consultation.

4. Balance number of cases with overwork and stress

Make sure that booked surgeries balance having enough patients to get a breadth of appropriate cases with the risk of overloading trainees. Give them time and catchups to get and stay in the right frame of mind for recording and review notes thoroughly.

5. Stay up to date

You and the trainee should read the RCGP RCA guidance on the website at regular intervals. this is updated very regularly and gives clear advice. Look at the FourteenFish help centre for lots of useful advice and also use the help facility as they are very responsive.

In particular ensure that your trainee is aware that there are mandatory requirements for their case selection to fulfil and that their choice of linkage to demonstrate this requires a statement of justification (December 2020).

6. Do not disturb

Make sure that everyone in the practice knows not to interrupt trainees. Use do not disturb signs on the door.

7. Get a timer

This is something on the desk to help the trainee know how long they’ve been consulting for. 

8. Consider aide-memoirs

Suggest the trainee has whatever reminders they find helpful next to the phone and computer such as identity check, consent, intro, impact, and ideas, concerns and expectations (ICE) etc to help them cover key points. Help them avoid this leading to overly structured consultations that don’t flow.

Make sure that they never, actually, use the question: “What are your ideas, concerns and expectations?”. It is three questions, not one, for a start, and they generally are best asked at different parts of the consultation.

9. Make notes

Provided it doesn’t impact on the flow of the consultation or rapport building, advise trainees to jot some key words and cues down while the patient is giving their opening statement. This is perhaps more suitable during telephone consultations.

10. Avoid typing

Try to avoid overuse of the computer and typing because this can distract from the flow of the conversation. 

11. Remember the examiner doesn’t know the patient

They can’t see medical records and so are unaware of past medical history, medication, and allergies. So, if relevant, verbalise them. However, doing this mechanistically before an appropriate point in the consultation will not add value or marks.

12. Set boundaries for help 

• This remains their exam to pass, it isn’t a joint submission.
• Agree with the trainee how many consultations you are realistically going to be able to review. 
• Make sure they’ve already reviewed and self-analysed the consultation before sharing it with you.
• Encourage them to be specific about what questions they have about each consultation. 
• Suggest they only share recordings that they think would pass or where they identify a competence area(s) which they are finding persistently challenging. 
• Don’t make promises or advise on whether the consultation is likely to pass or not. You don’t know that, so don’t say it. There is no appeal process so the trainee would have to conclude that you were wrong, not the examiners! Instead, give general formative feedback to trainees.

13.Teach them how to review their own consultations

• Remember, this is their exam to pass. Remove every barrier you can to them developing and demonstrating the skills and knowledge that they need to. But remember, not everyone is yet at the place where they should pass and you are doing the trainee a disservice if they pass when they weren’t truly ready.
• Teach them general principles of consultation self-analysis.
• Familiarise yourself with the marking scheme and grade descriptors and mark some together with a view to them marking their own.
• Avoid giving scores, keep feedback generic in the relevant domains and focus on specifics in terms of observed behaviours, knowledge, and decision making.
• Make sure they understand the guidance on Consent and Examining the patient which will be published on the RCGP website soon, and that if they flout this guidance their submission may not be marked.

14. Benchmark with non-examiner colleagues 

Refer to national guidelines to get a sense of what constitutes a passing consultation. (CSA examiners are not allowed to get involved with reviewing candidates’ consultations and, in particular, are not allowed to make comments about whether they are good, or likely to be passing consultations).

15. Look after yourself

You want your trainees to succeed but acknowledge that helping them prepare is time-consuming and stressful. Make sure that, where possible, your time is protected and negotiated with your practice to do the review work in practice time.

16. If your trainee fails

Check their feedback carefully and read the section on the website about how to use feedback statements.

17. Complicating factors 

Relationship between the clinical content and the complicating factors specific to the patient when considering which cases to select

Many of the trainees’ best consultations will be in one of the bold boxes, and therefore unsuitable for submission. This is explored in greater detail in Insufficient evidence (low challenge) cases in the RCA.

For example, patient expectations beliefs, beliefs, psychological issues, social situation, hidden agendas

More about MRCGP exams

• Recorded Consultation (RCA)
• Exam overview