How training progress is assessed

The Applied Knowledge Test (AKT) is a computer-based assessment that forms part of the MRCGP. It tests the knowledge base behind independent general practice in the UK within the context of the NHS. GP registrars who pass will show they can apply knowledge at a high enough level for independent practice.

The AKT takes place at Pearson VUE test centres across the UK.

The Simulated Consultation Assessment (SCA) will assess a candidate's ability to integrate and apply clinical, professional and communication skills appropriate for general practice. Candidates will be required to demonstrate they:

• can keep patients safe
• are adaptable in treating different types of patient and illness
• can manage risk, medical complexity and uncertainty
• exhibit the appropriate behaviour, attitude and concern in managing patients.

The assessment comprises 12 simulated consultations, each lasting 12 minutes, with three minutes' reading time for each of the 12 cases.

The cases are performed by role players who are trained, calibrated and standardised so that, although a case appears the same for every candidate, it responds to the approach of each individual doctor, as in real life. The cases will most commonly be patients, or in some instances their carer or parent or other health or social care workers, to reflect the various situations a GP may be presented with in everyday practice.

The SCA will be delivered via an online platform, with candidates sitting the exam in a local practice. Some cases will be on video, with the person appearing on camera. Other cases will simulate a consultation by telephone, with only the role player's voice being heard.

Workplace-based Assessment (WPBA) evaluates the GP registrar's progress in areas of professional practice that are best tested in the workplace. WPBA:

• looks at the GP registrar's performance in their day-to-day practice to provide evidence for learning and reflection based on real experiences
• supports and drives learning in important areas of capability with an underlying theme of patient safety
• provides constructive feedback on areas of strength and developmental needs, identifying GP registrars who may be in difficulty and need more help
• evaluates aspects of professional behaviour that are difficult to assess in the AKT and Simulated Consultation Assessment (SCA)
• determines fitness to progress towards completion of training.

Evidence of WPBA, as approved by the GMC, includes the completion of specific assessments and reports and the documentation of naturally occurring evidence as well as certain mandatory requirements such as child safeguarding and basic life support. More information on the WPBA requirements can be found on the RCGP website and a downloadable pdf summarising all the assessment and evidence requirements for WPBA across the training programme is available.

To ensure that standards are set at appropriate and realistic levels, a patient representative, newly qualified GPs and representatives of bodies with a stake in the outcome of the MRCGP examination (including the training community) are invited to act as either judges or observers, as appropriate, in the standard-setting process.

The RCGP has developed comprehensive guidance on what evidence an individual doing GP specialty training (GPST) and their educational supervisor could provide to ensure satisfactory progress and ultimately the capability for award of a CCT. Descriptors have been developed to provide guidance on the behaviours that a GP registrar is expected to demonstrate to display the required level of capability for a CCT, including indicators of underperformance and indicators of excellence. These ‘progression point descriptors’ have been explicitly mapped to the generic professional capabilities and are included in the curriculum under each core capability.

All GP registrars and supervisors participate in the GMC national training survey (NTS). This provides feedback for supervisors and programme directors on the quality of their teaching and their training programmes.

All GP registrars who undertake MRCGP AKT and SCA examinations are provided with feedback on their performance to help them understand or interpret a pass or fail result and guide future learning. In response to requests from candidates and supervisors, and in compliance with Academy of Medical Royal Colleges standards, we detail the feedback through the portfolio.

The AKT examiners publish feedback reports after every AKT. These are intended to guide the learning of GP registrars and to help trainers and training programme directors. GP registrars receive a breakdown of their marks under the three broad categories of clinical medicine, evidence interpretation and organisational questions.

SCA feedback is case-specific and linked to the marking domains. The feedback statements are not performance indicators and play no part in the marking process for the examination. The examiner will have marked the case before selecting the relevant feedback statements. Explanations of the feedback statements, with suggested learning strategies, can be seen in the portfolio. This feedback is intended for discussion with the educational supervisor or trainer, in the context of overall performance. SCA cases sample the curriculum but cannot cover every subject. This feedback relates only to the performance in those particular cases in the examination.

The RCGP keeps candidate feedback under constant review to try to make this as useful as possible to GP registrars and supervisors, while acknowledging the constraints imposed by a summative examination and the need for item and case confidentiality.