MRCGP: 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.
• 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, written (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).
• Recordings of individual consultations should be continuous.
• The camera should not be turned off during consultations and recordings must NOT be edited in anyway.

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.

This guidance is offered to encourage candidates to demonstrate their skills across a breadth of the curriculum and General Practice which would normally be selected for you in the CSA. It is not an exclusive list, nor do you have to consult with every example listed. However, the best way to ensure you demonstrate your skills across a breadth of the curriculum is by including a wide range of different consultations.

For example, you should aim to include:

• A spread of cases from across the curriculum with perhaps no more than two cases from any one curriculum area, reflecting the frequency of presentation within general practice and the great variety of work GPs face.
• A spread of ages (including where possible a child and an elderly patient).
• A case involving a mental health concern.
• If possible, a case with a long-term condition for example, cancer, multimorbidity or disability.
• A case related to urgent or unscheduled care.

We would suggest where possible you utilise new patient contacts rather than follow up patients as these are more likely to allow you to demonstrate your competence in consultation skills. Whilst it is recognised that many of the patients will have been triaged before the consultation begins, you 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.

Your workbook will help you check the variety in your submission, for example:

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. However, the RCA handbook currently contains only the clinical topic guide headings. 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.

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 consultations 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:

• 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.

• Recorded Consultation Assessment – Candidate Case Guidance (332 KB PDF)

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).

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.

• FourteenFish RCA platform 

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.

Please note:

• The RCA in July is available to trainees due to CCT on or before 30 September 2020. The platform has been designed to check the eligibility of applicants for this extra-ordinary sitting dependent upon their scheduled date to CCT. If you are in any doubt, please clarify this with your Educational supervisor or TPD.
• Access to FourteenFish is currently limited to trainees who receive the Certificate of Completion of Training (CCT) on or before 30 September 2020. This is to ensure that the new system is able to deal with those soon to complete training. After the July assessment, there will be clarification on the timing of future access.

All dates may be subject to change. Notice of any changes will be given at the earliest opportunity.

*July results: to process Annual Review of Competence Progression results and decisions rapidly, the marking of candidates' recordings will be randomised into two groups. This is why we have two different dates for the July results. Candidates will be told which date applies to them. We regret that it is not possible for a candidate to ask to be in a particular group for a date of publication of results.

Assessment dates will be allocated according to the trainee's due date of CCT and will not be changeable.

For eligibility to sit the RCA please refer to the RCA policy document (355 KB PDF).

Future RCA dates will be confirmed in due course.

Specific Learning Difficulties, such as dyslexia, may qualify for extra time in written exams like the Applied Knowledge Test where a candidate is expected to read and assimilate a lot of information in a limited time. 

The Recorded Consultation Assessment does not restrict the time for reading case notes or information in advance of recording the consultation. 

Adjustments in the time allowed, for dyslexia alone, are not usually eligible to be considered for a reasonable adjustment. 

It is not the responsibility of the RCGP to make reasonable adjustments for candidates’ consultations in the workplace. Candidates should liaise with the GP training practice or their employers about adjustments.

Complete a reasonable adjustment request form including the adjustments made in the workplace already with additional adjustments you would like made. Please refer to the guidance below before submitting your request.

• MRCGP Examination regulations
• Candidates with a Disability - Recorded Consultation Assessment (250 KB PDF)
• Recorded Consultation Assessment - Information for Disability Assessors (255 KB PDF)
• Recorded Consultation Assessment – Reasonable Adjustments Frequently Asked Questions (307 KB PDF)
• RCA Request for Reasonable Adjustment Form (302 KB PDF)

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 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.

• An analysis of passing/failing candidates in CSA (59 KB PDF)

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 ten minutes of the consultation submitted will be assessed. This time will not include any time for verbal consent that is recorded.

There may be allowance made for needing to leave the room for example, to collect a urine bottle, but the time taken for examinations will be part of that ten minutes. The camera should run continuously and not be turned off during the consultation submitted.

• RCA Grade Descriptors (39 KB PDF)
• RCA Domain Marking (51 KB PDF)

You are responsible for obtaining informed consent from patients, obtaining sign-off from your Clinical or Educational Supervisor and verification that the submission is your own work. You are responsible for ensuring that consultations are uploaded to the FourteenFish RCA platform by the published due date.

You are responsible for checking the quality of sound and picture of all the consultations you choose to submit.

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

The result of your examination along with any formative feedback will be published in your ePortfolio on the date given in the table on the Recorded Consultation Assessment tool page.

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.