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

7 August 2020

From keeping up to date with our latest guidance on the new exam to ensuring the dignity of patients in consultations, the RCGP in partnership with the Committee of GP Education Directors (COGPED) has some 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 early

Encourage the trainee to start recording as early as possible, so that they get into the swing of it.

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. 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 graphic.
  • Encourage trainees to demonstrate their skills across a breadth of the curriculum.
  • Ensure there is sufficient evidence in all three domains for the assessment.
  • Reception and administration staff need to be ‘on board’ and know what is happening.
  • Engage reception and triage clinicians to only book appropriate cases.
  • Simple triage consultations are unlikely to cover all three domains.
  • Give trainee permission to ‘be selfish’ and pick appropriate cases from other the lists of other clinicians.
  • 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 10 minutes, although if one might detract from the other, they might consider if this is an appropriate case.  

Clarification on examination of patients in Recorded Clinical Assessment (RCA) submissions - good medical practice. 
From 1 September 2020

The RCGP reminds candidates submitting cases for the MRCGP Recorded Clinical Assessment (RCA) about the importance of the dignity of patients and good medical practice

A consultation in which clothing equivalent to vest top and shorts, or the ‘swimsuit area’, is removed and captured on a visual recording must not be submitted for assessment.

If a consultation is submitted, where this guidance is breached, examiners have been advised that they should not continue to watch or assess it, and 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. 

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 stop clock

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

8. Consider crib sheets

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. 

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. 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.  

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. 

13.Teach them how to review their own consultations

  • 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 are available at: consent, and the guidance on intimate examinations 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. Don’t make promises 

You can give general formative feedback to trainees but avoid saying that consultations are ‘good enough’ or ‘will pass’. 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! 

16. Remove barriers, but don’t push trainees over the line

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. 

17. 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.  

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 red boxes, and therefore unsuitable for submission. This is explored in greater detail in a document soon to be published on the RCGP website.

Complicating factors 

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

 

Multiple factors to present

Some factors present

Complicating factors absent

High Clinical Challenge 

 

Extremely challenging consultation - excellent opportunity to display capabilities but case likely to be hard to complete in 10 minutes. Very challenging consultation - excellent opportunity to display capabilities. Challenging consultation- good opportunity to display capabilities.

Moderate Clinical Challenge

Very challenging consultation - excellent opportunity to display capabilities. Challenging consultation - good opportunity to display capabilities. Moderate level of challenge in consultation - some opportunity to display capabilities.

Low Clinical Challenge

Challenging consultation - good opportunities to display capabilities. Moderate level of challenge in consultation - some opportunity to display capabilities. Low level of challenge in consultation - very limited opportunity to display capabilities (insufficient evidence).

More about MRCGP exams



Post written by

RCGP and COGPED

COGPED (Committee of General Practice Education Directors) offers a forum for Postgraduate GP Directors to meet and share good practice. Its aim is to encourage and maintain a consistent approach to GP training across the United Kingdom. It is a focal point for communication between the Postgraduate GP Directors and other stakeholders such as Royal College of General Practitioners, BMA, GPC, NHS Resolution, GMC and various sections of Department of Health & Social Care.

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