MRCGP: Recorded Consultation Assessment (RCA)

The College RCA group have been developing this guidance to help the training community with the RCA. They continue in development and should not be considered as the final versions, rather, the latest. 

Key RCA information and advice

Recorded Consultation Assessment Candidate Handbook

The handbook relates to the Recorded Consultation Assessment (RCA) undertaken as an alternative to the Clinical Skills Assessment (CSA) until further notice while the COVID-19 disruption continues.

It describes the purpose and format of the RCA, and provides information about how to make an application, and how to collect and submit consultations.

Changes for the RCA to take effect from the September 2021 diet

The RCA will remain in place to allow for sufficient time for development of the new MRCGP performance assessment module. We have listened to feedback from candidates, GP trainers, the wider training community and other stakeholders.
 
In response to this feedback, and the valuable input from MRCGP Examiners (themselves practising GPs) based on their observations of submitted consultations, we are making some changes to the RCA. These will apply from the September 2021 diet, the submission deadline for which is 30 September 2021.
 
It is important to note that these changes cannot be applied retrospectively, and therefore there are no grounds for appeal from candidates who were previously unsuccessful in the RCA. The changes have been developed in partnership with the Committee of GP Education Directors (COGPED) representatives and are supported by the GMC:

Breast lumps (apart from those associated with the postnatal period) will no longer be considered for the mandatory criteria of maternal and reproductive health

The mandatory criterion was in place to ensure that candidates have the clinical skills to manage obstetrics and gynaecology. We have found that breast lumps score poorly as the management is a straightforward (but appropriate) referral to a fast-track clinic of a breast surgeon with no other management skills that align with the original intention of the criterion. There have also been many submissions of male breast lumps.

Clinical examination will no longer be a mandatory criterion

In trying to explain to patients what examinations will be carried out in the proposed subsequent face to face consultation, candidates appear to feel that they are required to talk to the examiner rather than the patient. Even in a video recording, the examination takes place behind a curtain. Hence, clinical examination will no longer be a mandatory criterion in the RCA, but clinical examination skills will continue to be assessed in Workplace Based Assessment.

The feedback statements and descriptors around safety netting will be changed to include the words 'appropriate' and 'realistic' safety netting

It has become apparent that some 'generic' safety netting by candidates such as 'phone 999' or 'go straight to A&E' can confuse and even upset patients. This clarification to the feedback statements and descriptors is intended to ensure candidates' safety netting is contextually appropriate to patients presenting complaints.

Increase the allowed length of time of the submissions from 10 minutes to 12 minutes for all cases

An increase in allowed time for every case was one of the biggest requests from the training community. It is recognised that 'real life' consultations can extend beyond 10 minutes, especially as the challenges of COVID continue. It is hoped that this increase in time for all cases will make candidates' RCA case selection easier, thus supporting them, their GP trainers and their practices.

What is the Recorded Consultation Assessment (RCA)?

The RCA is a summative assessment of a doctor's ability to integrate and apply clinical, professional, communication and practical skills appropriate for general practice. It uses pre-recorded video or audio consultations to provides evidence from a range of encounters in general practice relevant to most parts of the curriculum and also provides an opportunity to target particular aspects of clinical care and expertise.

Format of the RCA

  • The RCA will provide an objective assessment of clinical skills from real life settings provided across 13 consultations and undertaken by the candidate from their own current working environment. Due to the response to the pandemic situation it is likely that the majority of these will be conducted remotely.
  • The RCA will be sat during the ST3 year or beyond of training and recordings will be made during this time.
  • They may be any combination of audio, video or face to face consultations.
  • Cases will be submitted to a central facility - the FourteenFish RCA Platform.
  • Cases submitted should be of an appropriate level of challenge for an ST3 trainee to demonstrate safe and independent practice.
  • These cases will be assessed by trained and calibrated examiners who are experienced GPs.
  • Each consultation will be viewed independently by at least one examiner who will make a global judgement of that consultation, attributing marks in three domains and blind to other marks the candidate receives for that or any other consultation.
  • It is the responsibility of the candidate to obtain consent from the patient under the usual guidance for training and GDPR. This may be on the FourteenFish RCA Platform directly where this is used to record the consultation, in written form kept by the practice (paper/electronic) or verbally (on camera, the timing of which will not be counted as part of the ten minutes to be assessed or off camera, but a record kept).
  • Recordings submitted for the RCA will be deleted from the central IT platform after the Examination Board has ratified and published results. Material uploaded to the central IT platform but not submitted for the RCA will be deleted after 26 weeks (182 days). In exceptional cases, the Examination Board may approve retention for a longer period, the duration of which will be governed by GDPR principles.
  • Recordings of individual consultations must be continuous.
  • The camera should not be turned off during consultations and recordings must NOT be edited in anyway.

As per RCA Policy and in line with GDPR

  • No candidate should share their recordings for submission or potential submission to the RCA with anyone outside of their own Training Programme.
  • Candidates must not share their recordings in any preparation course for the RCA (Including RCGP preparation Courses).
  • The use of any service to screen cases prior to submission to the RCA is expressly prohibited.

Failure to adhere to this Guidance may result in referral to the GMC.

New and important clarification

From September 2021: EXAMINATION WILL NO LONGER BE CONSIDERED AS A REQUIRED MANDATORY CRITERION

This decision reflects feedback from candidates and educational supervisors as well as the observation of Examiners that this criterion is creating unusual consulting behaviour which is neither helpful nor understandable to patients and may increase their concern. It continues to be assessed under WPBA.

Consultations may still be submitted involving examination when appropriate.  Examinations are one way of demonstrating the competences of data gathering and inform clinical management. However, a set number of examinations  will not be a required Mandatory criterion.

It is the responsibility of the candidate and their Educational or Clinical supervisor to verify both the candidates identity and that the patients recorded are from genuine consultations within the candidate's approved general practice environment. The choice of 13 consultations should be the candidates' own. The Educational Supervisor is neither expected nor obliged to review these consultations.

A consultation that has previously been assessed, for example, as a COT may not be submitted for the RCA as it has already been used as evidence under WPBA. All cases submitted for the RCA should not be utilised for evidence under WPBA.

RCA consultations

The aim of the RCA is to test a doctor's ability to gather information and apply learned understanding of disease processes and person-centred care appropriately in a primary care context, make evidence-based decisions, and communicate effectively with patients and colleagues. Being able to integrate these skills effectively is a key element of this assessment 

The RCA focuses on testing the same areas of the GP curriculum (2018) as the CSA and as outlined on the How training progress is assessed page [818 KB PDF].

Specifically:

Knowing yourself and relating to others

  • Develop the attitudes and behaviours expected of a good doctor
  • Treat others fairly and with respect
  • Provide care with compassion and kindness
  • Establish an effective partnership with patients
  • Maintain a continuing relationship with patients, carers and families.

Applying clinical knowledge and skill

  • Apply a structured approach to data gathering and investigation
  • Interpret findings accurately to reach a diagnosis
  • Demonstrate a proficient approach to clinical examination
  • Adopt appropriate decision-making principles
  • Apply a scientific and evidence-based approach
  • Provide general clinical care to patients of all ages and backgrounds;
  • Adopt a structured approach to clinical management
  • Make appropriate use of other professionals and services
  • Provide urgent care when needed

Managing complex and long-term care

  • Enable people living with long-term conditions to improve their health
  • Manage concurrent health problems in an individual patient
  • Adopt safe and effective approaches for patients with complex health needs
  • Work as an effective team member coordinating a team-based approach to the care of patients.

Caring for the whole person and wider community

  • Demonstrate the holistic mindset of a generalist medical practitioner
  • Support people through individual experiences of health, illness and recovery; Understand the health service and your role within it.

Guidance on cases to submit

Updated 10 December 2020

This guidance is offered to encourage candidates to demonstrate their skills across the breadth of the curriculum and General Practice which would normally be selected for them in the CSA. It is neither an exclusive list, nor does the candidate have to consult with every example listed. However, the best way to ensure you demonstrate their skills across the breadth of the curriculum is by including a wide range of different consultations.

Mandatory Case selection criteria for RCA from November 2020 (Modified 13 July 2021)

In response to trainee feedback requesting further Mandatory guidance on case selection, and learning from the emergency Recorded Consultation Assessment (RCA) diets, mandated and recommended case criteria have been developed. A wider range of clinical topics allows a better review of candidates’ global capability and therefore provides better evidence on which to make a judgement of their readiness for independent practice as a GP. It is easier for candidates to gain marks and for the examiners to see candidates’ level of skill if a range of cases of a suitable, but not overly complex nature is submitted.

Read our guidance on Mandatory case selection

We would suggest where possible the candidate utilise new patient contacts rather than follow up patients as these are more likely to allow candidates to demonstrate competence in consultation skills. Whilst it is recognised that many of the patients will have been triaged before the consultation begins, the candidate should at the very least check with the patient whether your understanding of that triage process and its outcome aligns with theirs. Patients' stories and/or their needs frequently change between triage and consultation.

The workbook will help candidates check the variety in their submission and the Fishbase tool will help them check that their submission meets all the mandatory criteria and does not breach any guidance on examination of patients.

Candidates will be asked to describe in one sentence why they have chosen a particular case to demonstrate a mandatory criterion 
They are reminded that it is not acceptable to edit or pause the recording you choose to submit for the RCA. 

The 2018 GP curriculum and topic guides can be found on the RCGP website.

For reference please review the clinical topic areas as set out in the curriculum.

Topic guides about professional issues:

  • Consulting in general practice
  • Equality, diversity and inclusion
  • Evidence-based practice, research and sharing knowledge
  • Improving quality, safety and prescribing
  • Leadership and management
  • Urgent and unscheduled care

Topic guides about life stages:

  • Children and young people
  • Reproductive health and maternity
  • People living with long-term conditions including cancer
  • Older adults 
  • People at the end of life. 

Topic guides about clinical topics:

  • Allergy and immunology
  • Cardiovascular health
  • Dermatology
  • Ear, nose and throat (ENT), speech and hearing
  • Eyes and vision
  • Gastroenterology
  • Genomic medicine
  • Gynaecology and breast
  • Haematology
  • Infectious disease and travel health
  • Kidney and urology
  • Mental health
  • Metabolic problems and endocrinology
  • Musculoskeletal health
  • Neurodevelopmental disorders, intellectual and social disability
  • Neurology
  • Population health
  • Respiratory health
  • Sexual health
  • Smoking, alcohol and substance misuse.

You should use the full breadth of the curriculum topic guide areas in preparing recordings for submission. The FourteenFish workbook contains the life stages and clinical topic guide headings to match your case. If your consultation does not match one of these headings, there is the option to choose ‘other’. Please ensure you enter a short description of the case.

You will also be required  to link your case to mandatory criteria if appropriate with a sentence describing why you have chosen this required.

The RCA understands that consultations often cover more than one clinical topic, especially in the elderly with multimorbidity. You are therefore advised to choose what you regard as the most important topic covered during the consultation.

Low challenge cases are unlikely to give you the opportunity to demonstrate your consultation skills fully and will make it difficult for examiners to find evidence to meet the required performance criteria.

Examples of low challenge consultations might include simple lower urinary tract infections, straightforward skin conditions such as viral warts, uncomplicated upper respiratory tract infections and some follow up consultations.

However, any of these apparently low challenge cases can become more complex if, for example, significant psychosocial factors become apparent during the consultation. In general, more complex consultations are likely to give you the opportunity to demonstrate your consultation skills fully and meet the performance criteria required.

Examples of complex might include consultations with patients who are new to you, those with a significant psychosocial component, patients presenting with more than one problem, patients with multimorbidity, and consultations with more than one person.

Please note - behaviour that is merely for the benefit of the examiner rather than necessary, appropriate and realistic to the patient has been observed. This is confusing to patients and is likely to negatively affect the marking in either the clinical management or the interpersonal if it increases patient uncertainty and does not enhance patient care. It may indeed be harmful to patient care.

Such examples might include - an elaborate description of an examination which is not enhancing the patient understanding of their potential problem or might increase their anxiety.

Safety netting behaviours have also been observed which are likely to be detrimental to patient care - inappropriately increasing anxiety or suggesting inappropriate use of other resources such as out of hours or secondary care. An example might be a patient with a good description of Migraine type headache over 10 years who is told to dial 999 if things worsen before a scheduled examination later that day when they do not currently have a headache but are discussing prophylaxis.

Please note:

  • It is the responsibility of the candidate to be aware of the deadline for submission of cases and to work within this to make their submission in good time.
  • It is the candidate's responsibility to ensure the consultation recordings submitted are of good quality in sound and picture.
  • It is preferable in video or face to face consultations that the face of both the patient and the doctor are visible.
  • It is the responsibility of the candidate (and not their ES) to choose the recordings they wish to submit.

Mandatory guidance on examination of patients in Recorded Clinical Assessment (RCA) submissions - good medical practice.  Updated 10 December 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 the ‘swimsuit area’, is removed and can be seen on a visual recording must not be submitted for assessment.

The “swimsuit area” is defined as ;

  • For children up to age 2 years the area which would normally be expected to be covered by a “nappy”
  • For all male patients over the age of 2 years the area which would be covered by “Trunks”
  • For all female patients over the age of 2 years the area which would be covered by a “bikini” ie the “trunks area and breast ” 

If a consultation is submitted, where this guidance is confirmed as having been breached, no marks will be awarded for that consultation.

Examination may be continued out of line of the camera with suitable consent and chaperone in line with GMC guidance.

All candidates will be expected to verify in their online workbook that the case they are choosing to submit does not reveal on the recording any area of skin within this swimsuit area guidance for any length of time.

Guidance on consent

Each consultation that is recorded must be done with the informed consent of the patient and there should be no coercion. Informed consent must be sought before the consultation takes place, but it must also be confirmed after the consultation is over.

MRCGP RCA guidance and proforma consent form: Patient consent for recording of telephone and video consultations in general practice settings (766 KB PDF).

Delivery of the RCA

You will book for the RCA via the RCGP website. Once your booking is confirmed by the RCGP Examination Department you will be provided with a link to access the FourteenFish RCA platform on to which you will be able to submit recordings, or record directly.

The platform contains clear guidance about its functionality and how you can use the system to directly contact the patient and link to your chosen mode for example, mobile telephone. You will be able to upload a variety of recorded file formats to the platform. Recording of your consultations can, therefore, begin immediately.

Apply for the RCA

Apply for the RCA exam

  • You and your Educational or Clinical supervisor will need to verify your identity and that the patients recorded are from genuine consultations within your approved general practice environment.
  • The choice of 13 consultations should be your own. Your Educational Supervisor is neither expected nor obliged to review these consultations. 
  • A consultation that has previously been assessed e.g as a COT may not be submitted for the RCA as it has already been used as evidence under WPBA. 
  • All cases submitted for the RCA should not be utilised for evidence under WPBA.

Dates for applications, examinations and results

Declaring a disability or requesting special adjustments

Reasonable adjustments can be made to the RCA procedures where necessary to meet the needs of individuals who are disabled as defined by the Equality Act 2010.

Read our webpage on MRCGP equality and diversity to find out more.

Preparing for the RCA

The best preparation for the RCA is experience in general practice and seeing patients. You will have evidence of your progression from your WPBA observations such as COTs and CATs / CBDs and from feedback from your Clinical and Educational Supervisors.

As the RCA is designed to assess the same competences as the CSA it is anticipated that the same factors will affect candidates' performance in the RCA.

Find guidance for educators in Top tips to help your trainee prepare for the RCA: an educator's guide.

Resits

For support and advice, check our webpage on exam resits and reflection.

RCA marking

Each consultation will be viewed independently by at least one examiner who will make a global judgement of that consultation, attributing marks in three domains - data gathering, clinical management and interpersonal skills.

Each domain will earn a grade of Clear Pass / Pass / Fail or Clear Fail.

The first 12vminutes of the consultation submitted will be assessed. This time will not include any time for verbal consent that is recorded.

The time taken for examinations will be part of that 12 minutes. The camera should run continuously and not be turned off during the consultation.

Generic Grade Descriptors - updated 11 September 2020

Clear Pass

The candidate demonstrates a high level of competence, with a justifiable clinical approach that is fluent, appropriately focussed and technically proficient.

There is sufficient evidence provided to demonstrate capability in this domain.

The candidate shows sensitivity, actively shares ideas and may empower the patient

Pass

The candidate demonstrates an adequate level of competence, with a clinical approach that may not be fluent but is justifiable and technically proficient. The lack of complexity in the case presented restricts the achievement of a Clear Pass grade.

The candidate shows sensitivity and tries to involve the patient.

Fail

The candidate fails to demonstrate adequate competence, with a clinical approach that is at times unsystematic or inconsistent with accepted practice. Technical proficiency may be of concern.

There is limited (new) evidence provided to demonstrate capability of a doctor sufficient for safe independent UK General Practice.

The patient is treated with sensitivity and respect, but the doctor does not sufficiently facilitate or respond to the patient’s contribution.

Clear Fail

The candidate clearly fails to demonstrate competence, with a clinical approach that is incompatible with accepted practice, arbitrary or technically incompetent. 

There is no evidence or very limited evidence provided to demonstrate capability of a doctor sufficient for safe independent UK General Practice in this domain.

The patient is not treated with adequate attention, sensitivity or respect for their contribution.

Marking Scheme - updated 11 September 2020

I. Data Gathering, Technical and Assessment Skills

  1. Takes a focussed history to allow for a safe assessment to take place
  2. Elicits and develops relevant new information
  3. Rules in or out serious or significant disease
  4. Considers and/or generates any appropriate diagnostic hypotheses
  5. Explores where appropriate the impact and psychosocial context of the presenting problem
  6. Plans, explains and where possible, performs appropriate physical/mental examinations and tests
  7. Appears to recognise the issues or priorities in the consultation

II. Decision Making and Clinical Management Skills

  1. Appears to make a safe and appropriate working diagnosis/es
  2. Offers appropriate and safe management options for the presenting problem
  3. Where possible, makes evidence-based decisions re prescribing, referral and co-ordinating care with other health care professionals
  4. Makes appropriate use of time and resources whilst attending to risks
  5. Provides realistic safety netting and follow up instructions appropriate to the nature of the consultation

III. Interpersonal Skills

  1. Encourages the patient's contribution, identifying and responding to cues appropriate to the consultation
  2. Explores where appropriate, patient’s agenda, health beliefs & preferences
  3. Offers the opportunity to be involved in significant management decisions reaching a shared understanding
  4. When undertaken, explains and conducts examinations with sensitivity and obtains valid consent
  5. Provides explanations that are relevant, necessary and understandable to the patient

Video/audio recording and workbook

The candidate is responsible for:

  • obtaining informed consent from patients, obtaining sign-off from their Clinical or Educational Supervisor and verification that the submission is their own work. 
  • ensuring that consultations are uploaded to the FourteenFish RCA platform by the published due date and. checking the quality of sound and picture of all the consultations they choose to submit.

Guidance on recording consultations, consent and the short summary workbook are described in the relevant sections above.

PLEASE NOTE from September 2021 - consultation assessment is over 12 minutes starting after consent and identification and after which time the examiner will cease watching/listening to the consultation.

It is the candidates’ responsibility to ensure that their submission meets all the RCA requirements and does not breach any mandatory guidance on examination of patients, continuous recording and mandatory case selection criteria.

RCA results and feedback

The examination result along with any formative feedback will be published in candidates’ Trainee Portfolios on the date given in the table on the Recorded Consultation Assessment tool page.

Read the Recorded Consultation Assessment feedback statements

RCA Summary Reports from July 2020 to July 2021

Please bear in mind that the nature of the training cycle means that candidate cohorts differ considerably. The results for a particular diet should not therefore be used to draw any conclusions about the likely pass rates for other cohorts.

Summary of results for the July 2020 RCA examination

The results for the first RCA in July were split into two cohorts; prioritised in order to process CCTs for candidates in order of urgency.

The first set of results took in 9 days of examining for 607 candidates.

468 candidates were successful resulting in an overall pass rate of 77.1%. It is not a straightforward comparison to the previous CSA diet as this is a new exam and would represent a cohort who may have sat the previous CSA during March, April or May 2019. However, it can be noted that the overall CSA pass rate for academic year 2018-19 was 76.8%.

The proportion of candidates sitting the clinical skills examination for the first time was 72.2% and the pass rate for this particular group was 82.2%.

The mean score on this occasion was 158 out of 234 and the highest score was 207. A further 5 candidates obtained overall scores of 200 marks or more.

This second set of results took in 7 days of examining for 510 candidates.

369 candidates were successful resulting in an overall pass rate of 72.4%. It is not a straightforward comparison to the previous CSA diet as this is a new exam and would represent a cohort who may have sat the previous CSA during March, April or May 2019. However, it can be noted that the overall CSA pass rate for academic year 2018-19 was 76.8%.

The proportion of candidates sitting the clinical skills examination for the first time was 73.3% and the pass rate for this particular group was 78.6%.

The mean score on this occasion was 157 out of 234 and the highest score was 211. A further 4 candidates obtained overall scores of 200 marks or more.

Summary of results for the August 2020 RCA examination

The August RCA comprised 9 days of examining for 457 candidates.

337 candidates were successful resulting in an overall pass rate of 73.7%.

It is not a straightforward comparison to the previous CSA diet as this is a new exam and would represent a cohort who may have sat the previous CSA during March, April or May 2019.

However, it can be noted that the overall CSA pass rate for academic year 2018-19 was 76.8%. The pass rate for August was slightly up on that of the combined RCA in July which was 72.4%.

The proportion of candidates sitting the RCA for the first time was 78.1% and the pass rate for this particular group was 78%.

The mean score on this occasion was 158 out of 234 and the highest score was 204.

Summary of results for the November 2020 RCA examination

The November RCA comprised 15 days of examining for 883 candidates.

620 candidates were successful resulting in an overall pass rate of 70.2%.

The pass rate for November was slightly down on that of the RCA exams run in July and August in July. The combined pass rate for July and August was 74.6%

The proportion of candidates sitting the RCA for the first time was 84.03% and the pass rate for this particular group was 73%, although it should be noted that these figures are high due to the emergency exams not officially counting as an attempt towards the final four.

The mean score on this occasion was 154 out of 234 and the highest score was 203.

Summary of results for the February 2021 RCA examination

The February RCA comprised 10 days of examining for 494 candidates.

395 candidates were successful resulting in an overall pass rate of 80.0%.

The pass rate for February was higher than that of the RCA exams run previously, where the overall pass rate for all previous diets was 73%.

The proportion of candidates sitting the RCA for the first time was 77.73% and the pass rate for this particular group was 85%. The overall pass rate for this cohort from previous diets was 77%.

The mean score on this occasion was 159.9 out of 234 and the highest score was 208.

Summary of results for the March 2021 RCA examination

The March RCA comprised 20 days of examining for 1151 candidates. 
 
920 candidates were successful resulting in an overall pass rate of 79.9%. 

The pass rate for March was higher than that of most of the RCA exams run previously, but just less than February (80.0%) 

The proportion of candidates sitting the RCA for the first time was 88.18% and the pass rate for this particular group was 84%. The overall pass rate for this cohort from previous diets was 79%. 

The mean score on this occasion was 160.72 out of 234 and the highest score was 208.

Summary of results for the May 2021 RCA examination

The May RCA was taken by 1283 candidates.

998 candidates were successful resulting in an overall pass rate of 77.8%.

The pass rate for May was slightly lower than February (80.0%) and March (79.9%), but higher than the other RCA exams run previously.

The proportion of candidates sitting the RCA for the first time was 85.89% and the pass rate for this particular group was 81%. The overall pass rate for this cohort from previous diets was 80%.

The mean score on this occasion was 157.15 out of 234 and the highest score was 202.

Summary of results for the July 2021 RCA examination

The July RCA was taken by 233 candidates.

This is a small cohort, and one which is largely atypical of a regular cohort. In particular the number of UKGs on their 1st attempt (our usual reference group) was only 21 trainees. Only 51 trainees were on their 1st attempt which is a very low percentage compared to previous diets.

164 candidates were successful resulting in an overall pass rate of 70.4%.

The pass rate for July was lower than May (77.8%) and March (79.9%).

The proportion of candidates sitting the RCA for the first time was 21.89% and the pass rate for this particular group was 65%. The overall pass rate for this cohort from previous diets was 82%.

The mean score on this occasion was 149 out of 234 and the highest score was 194.

 

An interim report on the performance of the MRCGP Recorded Consultation Assessment

The Recorded Consultation Assessment (RCA), which was introduced as a response to the restrictions of the Covid-19 pandemic, has now been in use as the consultation assessment component of the MRCGP for 12 months, and during that time there have been eight sittings of the exam.

We understand that trainers, trainees, and stakeholders from the GP training community are interested in the performance of this new assessment, and so we are providing an interim update on the results and findings to date which we hope will be helpful and informative. This informal response will briefly outline the current situation, and a more detailed report will also be published in a peer-reviewed journal as soon as possible.

Although we typically publish a review of data annually, we monitor exam performance, including differential performance and differential attainment, as part of every AKT and RCA diet, and this is routinely shared with stakeholders, including COGPED, within every Exam Board meeting. The findings described below relate to the first seven sittings of the RCA, excluding the most recent diet in July 2021.

A note on interpreting the data

Any overlap of ethnicity with candidate sex and other characteristics means, for example, that International Medical Graduates (IMGs) are more likely to be from BME groups and less likely to be female. Place of primary medical qualification is also not synonymous with nationality since UK nationals choosing to study abroad are included in the IMG group. In 2019-20 as an example, a large proportion (17.78%) of unique candidates who sat an examination chose not to declare one of either their sex or ethnicity, and 12.93% chose to omit both sex and ethnicity.

Differential performance (marks achieved)

RCGP analyses differential performance of candidates on their first attempts by sex, source of primary medical qualification and – for UK graduates only – binary ethnicity (BAME or White). In each of these categories, differential performance is lower in the RCA. Even when measured by the classified effect sizes, differential performance remains unchanged and has not worsened.

Differential attainment (pass-fail outcomes)

RCGP also analyses differential attainment of candidates on their first attempts by sex, source of primary medical qualification and – for UK graduates only – binary ethnicity (BAME or White). In terms of source of Primary Medical Qualification and UK graduate binary ethnicity, there is less differential attainment in the RCA. In terms of sex, the results were largely the same.

Although improvements in differential performance and differential attainment in the RCA compared to the CSA are measurable, the statistical size of the improvements is currently very small. Their extent of the differences may become more pronounced as further RCA diets take place.

Of note, differential performance and differential attainment are also seen in the MRCGP Applied Knowledge Test (AKT) which is computer marked. Figure 1 shows pass rates for candidates on their first attempts by cohort type across the AKT, CSA and now RCA. This data is based on all examinations taken since 2014, over 22,000 AKT sittings and 21,000 CSA/RCA sittings. The differential attainment is starker within the AKT examination.

Figure 1

Exam

Pass Rate (UKG) %

Pass Rate (IMG) %

Pass Rate (White) %

Pass Rate (BAME) %

Pass Rate

(Female)%

Pass Rate (Male) %

AKT

82.5

45.4

88.1

73.1

76.2

68.7

CSA

89.6

44.1

94.6

81.5

84.0

70.0

RCA

91.6

49.6

97.3

84.9

81.4

64.5


Whilst there are performance differences between subgroups of candidates, GMC differential pass rate data confirm RCGP performance differences compare favourably with those of some other Royal Colleges. The GMC agrees, in all specialties, that the causes of differential performance and differential attainment are multifactorial and are unlikely to be solely due to the format and nature of the exit examination or bias (conscious or unconscious) amongst examiners. A collaborative approach across the whole educational community will be required to affect real, meaningful change.

RCGP remains committed to delivering a fit-for-purpose examination which is fair for all candidates. Reducing differential performance and differential attainment within the MRCGP remains a high priority within continuing development of the RCA. We have listened to stakeholder feedback and, from September 2021, RCGP has lengthened the time available in each RCA case from 10 to 12 minutes; made changes to mandatory criteria to make case selection easier; enhanced RCA feedback statements; and improved support resources for GP Trainers.

RCGP will also prioritise the reduction of differential performance and differential attainment in the development work for a new MRCGP clinical module which is planned to be implemented from 2023.

RCGP has a duty of care to set an appropriate standard to ensure that those passing MRCGP have the appropriate competences to become safe, independent general practitioners. The GMC and the RCGP are confident that the RCA and wider MRCGP tripos continue to fulfil this role.

Complaints, Reviews and Appeals

For detailed information on complaints, reviews and appeals please refer to the RCA policy document and the MRCGP regulations, reviews, appeals, complaints and mitigating circumstances.

Contact us

Tel: 0203 188 7660
Email: exams@rcgp.org.uk

Data protection impact assessment procedure

Read our Data Protection Impact Assessment Procedure for gaining consent, recording, and examining consultations for the new Recorded Consultation Assessment

 

 

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