MRCGP exam resit support for GP trainees

After the initial disappointment, and maybe surprise that you have not passed your exam, it can be helpful to reflect systematically on the event. This might prove difficult or even painful, as you are reviewing feelings and behaviour as well as knowledge and skills, but reflection is a tool to help you to move forward with insight and thus to plan re-sit preparation more effectively. It can be difficult to engage with examination feedback; some of the messages may not be what you want to hear. Despite this, feedback is your friend and it’s essential to reflect on it and discuss it with your supervisor.

3 steps to reflect and resit

The following is an example on how to reflect in a structured way on your result in order to inform your future actions. It is not a blueprint and can be adapted to fit your particular learning style.

There are 3 steps that you should undertake:

Step 1: Gather insights and research on the support available to you

This step involves reaching out for insights and information. Having access to as much information as possible is crucial for making sure you're in a better place for your next attempt. This step is also about making sure you're getting the wellbeing support you need if you're experiencing difficult feelings over your result.

Use available resources

You might find it helpful to go online and collate materials and resources to give you more insights around your exam.

For example, you can access:

  • Range of MRCGP website materials
  • Other websites, e.g. exam preparation sites, dealing with nerves, techniques for approaching difficult questions
  • Materials from any preparation courses • Copies of the curriculum, for systematic preparation and checking
  • Practice tests • Crib sheets
  • Feedback from trainers and practice colleagues
  • Discussions with peers also siting the exam

AKT feedback reports

The AKT examiners publish feedback reports after every AKT. They're intended to guide the learning of AiTs and to help trainers and training programme directors.

AKT feedback reports from the past two years:

  • January 2021 AKT Feedback Report (132 KB PDF)
  • October 2020 AKT Feedback Report (242 KB PDF)
  • August 2020 AKT Feedback Report (231 KB PDF)
  • July 2020 AKT Feedback Report (115 KB PDF)
  • January 2020 AKT Feedback Report [PDF]
  • October 2019 AKT Feedback Report [PDF]
  • AKT feedback report for the past five years:

  • January 2016 to January 2021 AKT feedback report (140 KB PDF)
  • Step 2: Reflect on your previous exam preparation and performance

    This step involves looking back over the exam and identifying the things that you think contributed to your exam result. It also includes reviewing your exam preparation so you can see whether it covered the issues you have identified and/or did so in sufficient detail or depth.

    Reflection is an absolutely vital process, to safeguard against repeating the same pitfalls as last time, while preserving your strengths and successes.

    What strategies did you use for your exam preparation?

    Think back on the resources you gathered during step 1. Compare these to the resources, techniques and processes you employed when you prepared for your previous exam attempt. Identify any gaps, or areas you can put more investment into this time.

    What might have contributed to your result?

    The main purpose of this exercise is to help you identify what went wrong so you can think about why, and then move on. Brooding, over-thinking or dwelling on particular details of the test are not productive reflective strategies.

    Some examples of what may have impacted your exam performance:

    • Nerves
    • Running out of time / time management
    • Difficulty with one or more areas, such as lack of understanding or knowledge
    • Problems understanding exam requirements
    • Losing focus after struggling to answer one question
    • Unfamiliarity with testing format
    • External pressures or extenuating circumstances impacting on exam preparation
    • Insufficient time devoted to exam preparation

    AKT considerations:

    • Did not have formative discussion with ES about timing of exam entry
    • Problems understanding some of the language
    • Unfamiliarity with some of the UK medical or administrative systems

    RCA considerations:

    • Time management which made it difficult to select adequate 10-minute consultations
    • Difficulty with one or more assessment domains (data gathering, clinical management or interpersonal skills)
    • Difficulty with one or more clinical topics
    • Misunderstanding of mandatory criteria (which may have led to a MC breach)
    • Technical problems with recording consultations

    Resources to help with reflection and reflective practice

    Step 3: Use the research and reflections you've gathered to prepare for your resit

    When looking at available resources and your own test feedback, it is easy to focus on the areas which were not to standard. It is equally important to note carefully what went well so you can reproduce it again. Reflection should always celebrate the good: it is a solid base on which to build.

    When preparing for your resit, you might want to consider the following points.

    Use feedback from tests to inform preparation

    Discuss with your peers and supervisors the best ways to use your test feedback and built upon it.

    Don’t fight test feedback. It can be tempting to spend time working out why you disagree with a particular judgement. Your memories of an individual question or consultation might include a self-assessment of how you think you performed. However, you were managing the interaction whilst the examiner was solely focussed on your performance and assessing it against fixed criteria.

    Prepare and practise

    • Arrange local trainee groups
    • Get supervisor feedback during tutorials
    • Attend locally arranged courses if available
    • Balance adequate revision with outside commitments
    • Share any problems with your ES
    • Seek help for any language difficulties by contacting the Deanery for advice

    Consider strategies for dealing with exam behaviour and technique

    • To help with nerves, try consulting the web, asking peers and supervisors for suggestions, and seeking medical advice.
    • To help with time management for the AKT, try practising mock assessments so you can get used to the different styles of questions, and understand the time spent on each section of the exam.
    • To help with time management for the RCA, practise consulting within the 10-minute window and try to get to management by 6-7 minutes.

    If appropriate, consider a dyslexia assessment

    If you think you might have Dyslexia, it’s important to act as soon as possible and discuss your concerns with your ES.

    If diagnosed early, support can be put in place and you will be able to develop coping strategies not just for exams but for other day to day work as well.

    Screening doesn’t necessarily mean diagnosis. It just means if you screen positive you can go on to have a fuller assessment from a qualified EP with costs borne by the Deanery. Deaneries can refer to Access to Work much earlier and get funding support for trainees.

    A formal diagnosis from an educational psychologist will take time to get in place. Once you have a formal diagnosis, where deemed necessary a reasonable adjustment can be made for the exam for example, allowing you to have extra time.

    Resources you may find useful:

    Case studies

    I didn't pass my AKT

    The following case study was compiled following telephone conversations with a practising doctor who initially failed their exam.

    After my first attempt at the AKT I wasn’t sure if I’d passed or not. And in fact, I failed by a very few marks. So, I wasn’t particularly upset. You have to allow yourself to fail. It’s a strange exam in that it’s a broad programme of study but the test questions are quite specific.

    The feedback showed that a weak area had been administration. So preparing for my re-take I focussed more on that. I used the Fourteen Fish video and reviewed the details of regulations for areas such as driving. I started my training in Italy so perhaps I should have allowed more time for preparation in that area given that there are differences between the two administrative systems.

    Timing is important. Halfway through my second attempt, I realised that I needed to speed up a bit or I wouldn’t finish. It’s easy to spend too much time thinking about the early questions.

    It’s important to work out the best time to attempt the AKT. Not everyone’s situations are similar. For me, looking back, I would have taken it the first time in the February of my second year, allowing for a re-sit in May.

    After the second attempt, many of us thought we might have failed. In fact, most of us passed. I did – and I am working as a doctor now.

    I didn't pass my RCA

    The following case study is not based on the experience of a single individual; it is compiled from comments made by several trainees of their experiences of the RCA.

    Obviously, I was disappointed when I found out that I hadn’t passed the RCA. In the period leading up to the exam I had been quite anxious – the RCA is new and there were lots of uncertainties. Choosing cases was difficult working with a 10-minute time frame - most consultations take longer with COVID. Though I found that through aiming for 10 minutes for the RCA my consulting generally speeded up which has been really helpful day to day. Also, preparing for the exam, I found it was hard to conduct "normal" consultations with patients, as I was constantly looking for specific types of cases. But after I had submitted my consultations, I felt reasonably confident – I felt like I had a good spread of cases including some consultations I was really pleased with. So, I was a bit surprised to find that I hadn’t passed, and it took me a little while to accept that and to reflect on what I needed to do differently when I retook the RCA.

    It really helped me to discuss the RCA failure with my supervisor. We revisited the guidance for the RCA on the College website and, looking again at what it says about low challenge cases I realised that I had not got this right the first time.

    Some of the consultations I had submitted involved quite complex clinical areas and I hadn’t thought of these as being ‘low challenge’. However, when I thought about them again, I realised that they were possibly not complex enough from a communication or data-gathering point of view. Some of the patients we come across (in a practice that includes an upper-middle class suburb) are very well-informed. In two of these cases, I had asked the patients what the problem was, and they had basically told me everything without me needing to do much at all. One of these consultations was with a patient who was particularly articulate and knowledgeable. On reflection, it was obvious that I hadn’t really been able to demonstrate much in the way of data-gathering skills as a result. although facilitating a knowledgeable patient to speak may have scored me positively in interpersonal skills.

    When I took it the second time, and passed, I included some cases where the medical condition was complex, and I had to work hard to sort the complexity out, and others with patients with a simple medical problem, about which they were initially coy and where I had to work quite hard to get any information out of them. I passed. After all, the exam is about Consulting Skills, not my and the patient’s knowledge of complex medical conditions.

    References

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