Mandatory Case selection criteria for Recorded Consultation Assessment

From November 2020

Background

In response to trainee feedback requesting further guidance on case submission, 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.

Definitions:

‘Case selection criteria’

These specify factors that have a direct and significant impact on the consultation and provide the candidate with an appropriate opportunity to demonstrate the relevant curriculum capabilities. The profile of these cases will have a demonstrable influence on at least one of the three domains of the assessment:

  1. Data gathering
  2. Decision making and clinical management
  3. Interpersonal skills

'Mandatory’

For RCA examinations from November 2020 onwards, all candidates are required to submit a range of consultations that include evidence for all the criteria designated within this group. Submissions will be reviewed to ensure compliance. Failure to comply will affect the eligibility of their submission and the loss of the relevant marks. Sanctions are outlined in the RCA Policy Document (409 KB PDF) in summary:

Mis-labelled criterion

Sanction:
Will be considered as a case omission and zero marks will be attributed to that case unless the criterion is found to be satisfied elsewhere within the submission.

Single omitted criterion

Sanction:
Zero marks will be attributed to that case.

Two or more omitted criteria

Sanction:
Whole submission is declined and re-application is advised. A refund of fee is not appropriate.

Case submitted breached the mandatory guidance on examination of patients in the RCA

Sanction:
Zero marks will be attributed to that case.

Case submitted breached the rule on continuous or edited recording

Sanction:
Zero marks will be attributed to that case. In the case of editing , the Exam board may refer the matter to the Responsible Officer of the candidate to consider further action.

Two or more breaches

Sanction:
Whole submission is declined and re-application is advised. A refund of fee is not appropriate.

‘Recommended’

Whilst not all these criteria will be included in submissions by all candidates, it is advised that by doing so, the candidate will enhance their opportunity to demonstrate capabilities relevant to the RCA domains.

Note: a single consultation may satisfy more than one criterion. For example, a case of a child presenting to an urgent consultation during which the details of and consent for an examination was explained, would satisfy three of the criteria listed, as would a consultation with an elderly patient with a tremor who was then examined.

Requirements for case submissions:

The following criteria for case submissions are deemed mandatory in all diets of the RCA from and including November 2020 onwards. Candidates will be asked to provide a declaration that the cases within their submission meet the mandated requirements.

Candidates will be allowed to link up to two possible cases for  each mandatory criteria (four for examination cases)  in their submission on Fourteen Fish (FishBase) and will be asked to complete a sentence to justify their choice.

“I have chosen this case to demonstrate (Insert mandated case selection criterion  ) because…….”

Such that, of the total thirteen consultations chosen, a maximum of four may be linked to clinical examination and two for each of the other criteria.

Please note:-  that whilst a case may represent more than one criteria, in doing so this may inadvertently cause a double breach if that case were disallowed. Candidates may chose therefore to allocate a single criteria best suited to a case rather than multiple links to fewer of their selected cases. 


Mandatory case selection criteria  

Requirement

RCGP Curriculum capabilities and topic areas

1. One case involving a child aged 16 years or younger (including by proxy) At least one case involving a child aged 16 years or younger (can be by proxy)
The consultation should reflect the impact of the patient being a child, rather than simply incidental to the clinical scenario
GP curriculum - Life stages topic guides - Children and young people
2. Minimum of one older adult (over 65 years) Minimum of one older adult (age 65 years and older) GP Curriculum - Life stage topic guide - older adults
3. Essential clinical areas -

These consultations should reflect the impact of the condition on the patient, rather than it simply being incidental to the clinical scenario.

Minimum of one case involving each of:

A - An acute problem that needs urgent investigation or referral

B - Maternal and reproductive health

C - A Mental Health Condition within the DSM or ICD classifications

D - A long-term condition e.g. cancer, multimorbidity or disability

A - This criteria includes the “Urgent and Unscheduled care guidance” in the curriculum but is expanded to include assessment of an acute (New presentation or change in condition) requiring immediate assessment or urgent (immediate or within 2 weeks) investigation or referral. 

There should be evidence of this within the submitted consultation rather than from  developments within the case after the consultation. 

This criterion DOES NOT NECESSARILY INCLUDE a patient requiring examination to complete the data gathering of a new presentation, unless it is evident that such an examination is essential to confirm/refute a potentially urgent problem. 
(see below for definition of examination)

GP Curriculum - Professional topic guides Urgent and unscheduled care

B - Maternity and Reproductive health - definition under RCA Mandatory criteria- may be interpreted as a wider clinical area than under the GP Curriculum documentation. It may include all areas pertaining to Maternity care pre, intra and postnatal issues both physical and mental. Reproductive Health may include areas of Sexual Health (including contraception and infections such as HIV and sexually transmitted infections for all genders) and Gynaecological problems (including menopause, HRT and for example, vaginal bleeding problems) IT DOES NOT INCLUDE passing enquiry about for example sexual function as part of urology assessments. 

GP Curriculum - Maternity and reproductive health.

C - GP Curriculum - Mental health

D - A long-term condition (LTC) is defined here to mean any pre-existing medical condition that cannot currently be cured but can be managed with the use of medication and/or other approaches and therapies.
It should be an established diagnosis in the patient. This criteria DOES NOT INCLUDE a potential LTC which is being considered or diagnosed for the first time

GP Curriculum - People with Long-term Conditions including Cancer.

4. Minimum of 2 cases requiring either a clinical examination or an explanation of the clinical examination required to the patient (psychiatric examinations are included in this definition).  Clinical Examination is still considered an important component of the assessment and remains essential within the practical and ethical constraints of a recorded consultation.

It is not sufficient to merely state that an examination is required.
Please note: Clinical examination forms part of your data gathering where you confirm or refute your differential diagnoses from your history by examining the patient. In the current environment, many consultations are by telephone and it is then arranged for the patient to attend the surgery for an examination if required - we would expect that the doctor would explain clearly to the patient what that examination might involve and how that would influence their subsequent management. Simply stating “we need to examine you” does not satisfy this criterion. .
Please note- the guidance on avoiding visible recording of a patient who has had removal of clothes in the “swimsuit” area.
'Recommended' case selection criteria  

Requirement

RCGP Curriculum capabilities and topic areas

 5. No more than 2 cases where the focus of the consultation lies in any one of the Clinical Topic Areas as listed in the GP curriculum*** The spread of cases should be broad to demonstrate competence across the GP curriculum. The main focus of each case should be within a different clinical topic area of the curriculum.

The RCGP Curriculum: The curriculum topic guides

The clinical Topic Areas are listed at:
Case guidance - overview

The detail on each area is explored at:
Curriculum Topic Guides

6. Varying spread of clinical cases and levels of challenge in the consultation  Consideration should be given to the complexity of the consultations submitted, for example in terms of patient expectations, beliefs, social situation, psychological issues, hidden agendas.

Top tips to help your trainee prepare for the RCA: an educator's guide

Case guidance - overview

Detailed candidate case guidance (332 KB PDF)

Insufficient evidence (low challenge) cases in the RCA


  *** These include Clinical Topic areas as listed in the GP Curriculum, Reproductive health and maternity, People with long-term conditions (including cancer) and People at the end of life (From Life stage Topics).

Exceptional circumstances

The only exceptions allowed will be military trainees working solely in military training practices during ST-3, where there is limited or no opportunity to consult with children under 16 or the elderly due to the practice demographic in these locations.

Capability in consulting with these patient groups will be demonstrated and evidenced elsewhere during a military GPST programme. Confirmation of the limited demographic will be affirmed through the Defence Deanery PHC Dean.

Compensatory evidence of capability in consulting with wider patient groups will be confirmed by the Defence Deanery through review of portfolio evidence by the end of the trainee programme.

No exceptions will be allowed for any other reason.

Candidates who are having difficulty meeting any of the mandated requirements because of the demographics of their practice, should approach their local HEE Office / Deanery to see if an alternative arrangement might enable them to fulfil the criteria.

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