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.
• 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.

New and important clarification December 2020

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.

Where this guidance uses the terms ‘male’ or ‘female’ it refers to an individual’s gender identity which may or may not be the same as the sex they were assigned at birth

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.  

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.

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.

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 10 December 2020)

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 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.
• 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.

• Recorded Consultation Assessment – Candidate Case Guidance (332 KB PDF)
• Read our blog on Top tips to help your trainee prepare for the RCA: an educator's guide.
• Insufficient evidence (low challenge) cases- advice to candidates
• Mandatory Case selection criteria for Recorded Consultation Assessment from November 2020

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.
• The choice of 13 consultations should be your own. Your ES 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.

   

Please note

The RCA is available to trainees in ST3 or beyond. The platform has been designed to check the eligibility of applicants  dependent upon their scheduled date to CCT. If you are in any doubt, please clarify this with your Educational supervisor or TPD.

 For dates of application review the RCA section of the MRCGP exam applications.

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 reasonable adjustments to find out more.

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.

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

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

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.

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.

• Generic Grade Descriptors
• RCA Domain Marking

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 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

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.

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.

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

Read the Recorded Consultation Assessment feedback statements

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.

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.