How training progress is assessed

The MRCGP is an integrated assessment system, success in which confirms that a doctor has satisfactorily completed specialty training for general practice and is competent to enter independent practice in the UK without further supervision. Satisfactory completion of the MRCGP is a prerequisite for the issue of a CCT and full membership of the RCGP.

The MRCGP comprises three separate components – an Applied Knowledge Test (AKT), a Clinical Skills Assessment (CSA) and Workplace-Based Assessment (WPBA) – each of which tests different capabilities using validated assessment methods and which together cover the spectrum of knowledge, skills, behaviours and attitudes defined by the GP specialty training curriculum.

The MRCGP complies with GMC standards on validity, reliability, feasibility, cost-effectiveness, opportunities for feedback and impact on learning. It also follows best practice in assessment, quality assurance and standard setting, as well as expectations about the currency of national professional examinations and the number of attempts permissible, as set out in relevant Academy of Medical Royal Colleges and GMC guidance. Annual reports with key information on MRCGP performance are available on our website.

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Educational Supervisor's Review

The Educational Supervisor's Review (ESR) is a structured review of and judgement on your progression. You will need to complete a self-assessment of your progression against each of the capabilities. The supervisor equally rates these capabilities and, along with all of the available information within your ePortfolio, which includes assessments, naturally occurring evidence and reports, makes a global judgement on your progression. This feeds into the ARCP assessment (see Table 3), which all trainees are required to undergo on an annual basis.

 

ST1

ST2 

 ST3

   Old  New  Old  New  Old  New
Mini-CEX/COT
from any setting:
Face-to face telephone or video)
6  4 6  4  12  7
             
CBT/CAT 6 4Cbd 6  4CbD  12  5 CAT
MSF 2 1 (with 10 responses) 0 1 (with 10 responses) 2 2 (1 MSF,
1 Leadership MSF)
CSR 1 per post 1 per post* 1 per post 1 per post* 0  1 per post*
PSQ 1 (in GP) 0 0 0  1  1
CEPS Ongoing Ongoing
Ongoing
Ongoing Across 3 years
5 intimate plus a range of others
Across 3 years
5 intimate plus a range of others
Learning Logs Many 36 Case Reviews Many 36 Case Reviews
Many 36 Case Reviews
Placement Planning Meeting Suggested 1 per post Suggested 1 per post
Suggested 1 per post
QIP 0 1 (in GP) 0 1 (in GP) - if not done in ST1 0 0
Significant Event - Only completed if reaches GMC threshold of potential or actual serious harm to patients - Only completed if reaches GMC threshold of potential or actual serious harm to patients
- Only completed if reaches GMC threshold of potential or actual serious harm to patients
Learning Event Analysis (LEA) Several - previously called SEA 1 Several - previously called SEA
1 Several - previously called SEA 1
Prescribing Review 0 0 0 0 0 1
Leadership 0 0 0 0 0 1
Interim ESR 0 1** 0 1**
0 1**
ESR 2 1 2 1 2 1

Table 3: Assessment numbers from August 2020

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Curriculum and assessment blueprint

Every capability described in the curriculum is directly linked to one or more of the MRCGP assessments (see Table 4). You must pass these assessments to successfully complete GP specialty training and gain a CCT.


 

RCGP curriculum blueprint 2018

 
Curriculum theme 
 
 Curriculum capabilities / competences to be demonstrated before exit from training
WPBA     
CAT / CBD  COT  CEX   CEPS  PSQ  MSF  CSR CSA  AKT 
1. Knowing yourself and relating to other Fitness to practise

Develop the attitudes and behaviours expected of a good doctor

Manage the factors that influence your performance

•   •

 •

 •

 •

 •  •
 Maintaining an ethical approach
Treat others fairly and with respect, acting without discrimination

Provide care with
compassion and kindness








 •


 •


 •


 •


 •


 
Communication and consultation

Establish an effective partnership with patients

Maintain a continuing relationship with patients, carers and families





 •


 •


 •


 


 •


 •


 
2. Applying clinical knowledge and skill Data gathering and interpretation

Apply a structured approach to data gathering and investigation

Interpret findings accurately to reach a diagnosis

Demonstrate a proficient approach to clinical examination*
















 





 •





 •





 •


Clinical examination and procedural skills

2.3 Demonstrate a proficient approach
to clinical examination*

2.4 Demonstrate a proficient approach to the performance of procedures*

Demonstrate a proficient approach to the perfomance of procedures*

 












 •





 •


 
Making decisions

Adopt appropriate decision-making principles

Apply a scientific and evidence-based approach

 •


 •
 •


 •


 •  •


 •


 •


Clinical management

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













 •







 •






 •


 •








 •








 •








3. Managing complex and long-term care Managing medical complexity  
 

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












 •





 •



 •  •





 •





 •


  Working with colleagues and in team
 

Work as an effective team member

Coordinate a team-based approach to the care of patients




 

 •

 •

 •

 •

 •

 
4. Working well in organisations and systems of care Maintaining performance, learning and teaching

Continuously evaluate and improve the care you provide

Adopt a safe and scientific
approach to improve quality of care

Support the education and development of colleagues








 •  •





 •





 


Organisational management and leadership

Apply leadership skills
to help improve your
organisation's performance

Develop the financial and business skills required for your role

Make effective use of information management and communication systems









 






 






 



 •







 •





 



 






5. Caring for the whole person and wider community Practising holistically and promoting health

Demonstrate the holistic mind-set of a generalist medical practitioner

Support people through individual experiences of health, illness and recovery












 •


 •  •


 •


 
Community orientation

Understand the health service and your role within it

Build relationships with the communities with which you work

 •

 •

 •  


 •


 •


 •  •

Table 4: RCGP Curriculum blueprint

Applied knowledge test

The AKT is a summative assessment of the knowledge base that underpins independent general practice in the UK within the context of the NHS. Trainees who pass this assessment will have demonstrated their capability in applying knowledge at a level that is sufficiently high for independent practice.

Clinical skills assessment

The CSA is a summative assessment of a doctor's ability to integrate and apply clinical, professional, communication and practical skills appropriate for general practice. Simulating a typical GP’s work, the CSA assesses a range of scenarios from general practice that are relevant to most parts of the curriculum, which can also target particular aspects of clinical care and expertise.

Workplace based assessment

The WPBA evaluates a trainee's progress in areas of professional practice best tested in the workplace and looks at the trainee's performance in his or her day-to-day practice to provide evidence for learning and reflection based on real experiences. It supports and drives learning in important Areas of Capability, with an underlying theme of patient safety. Specific tools provide constructive feedback on areas of strength and developmental needs, identifying trainees who may be in difficulty and need more help. The WPBA plays an essential role in evaluating aspects of professional behaviour that are difficult to assess under the 'exam conditions' of the AKT and CSA. This helps to determine 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 capabilities in child safeguarding and basic life support.

All of the assessments completed in the workplace have a formative function, with trainees given instant feedback on their performance, and these all contribute to the decision about a trainee's progress.

Case based discussion

The Case-based Discussion (CbD) is a structured oral interview designed to assess your professional judgement in a clinical case. It assesses your performance against the capabilities and looks at how you made holistic, balanced and justifiable decisions in relation to patient care. It assesses your understanding and application of medical knowledge and ethical frameworks, your ability to prioritise and how you recognised and approached the complexity and uncertainty of the consultation.

Care assessment tool

This tool includes CbDs and it has been introduced for trainees in ST3. It allows you to demonstrate your performance in other activities, which can be assessed in your GP rotation. The Care Assessment Tool (CAT), like CbDs, assesses your abilities against the capabilities and feedback is given immediately. Examples of CATs include a case review, a review of referrals or a review of prescribing to follow up the prescribing assessment.

Clinical evaluation exercise

The Clinical Evaluation Exercise (miniCEX) assesses your clinical skills, attitudes and behaviours while consulting with patients. The assessments need to cover a range of different clinical problems. Your supervisor will observe your interaction with a patient and provide immediate feedback on your performance. This assessment is completed during your hospital placements and is replaced by the Consultation Observation Tool (COT) during your GP rotations.

Consultation Observation Tool, which includes the Audio-COT

The COT which includes the Audio-COT assesses your consultations within the primary care setting. As with the miniCEX, it gives you an opportunity to demonstrate your performance and competence in consulting and it assesses the clinical skills and professionalism necessary for good clinical care.

In addition, it includes your performance of the more holistic judgements needed to consult in general practice. Immediate feedback is provided on your performance. The COT assesses face to face consulting be that with patients in your consulting room or via video links, whilst the Audio-COT assesses your ability to consult on the telephone. Different assessment forms are used to reflect the different skills needed to carry out a consultation safely within these settings. It is recommended that your assessments cover both settings.

Multi source feedback tool

The Multi-source Feedback (MSF) tool is used to obtain your colleagues' opinions of your clinical performance and professional behaviour. The responses are amalgamated and allow you to reflect, evaluate and develop a learning plan if any issues arise.

Patient satisfaction questionnaire

The Patient Satisfaction Questionnaire (PSQ) asks your patients to assess your performance within the consultation. It provides feedback on your empathy and relationship-building skills. As with the MSF tool, you are required to reflect on the assessment and develop an action plan if any issues arise.

Clinical examination and procedural skills

The assessment of clinical examination and procedural skills (CEPS) is an assessment of your ability to perform examinations and procedures with patients and should cover the full range of examinations required in general practice. In addition, there are five specific GMC-mandated intimate examinations: breast, rectal, prostate and male and female genital examinations.

Leadership activity

Trainees need to complete a leadership activity while in GP training. This activity needs to demonstrate your organisational skills, your willingness to take responsibility for your own decisions, team management and your understanding of health service management. Your activity needs to be presented to your team. MSF will need to be completed by your peers after the activity.

Quality improvement project

This activity is designed to assess your competence in your understanding and completion of a quality improvement project (QIP). You are assessed on your choice of project, how you effectively measured the data, your use of quality improvement methods, your suggestions for change, how you involved the team and your evaluation of any proposed changes and their impact.

Prescribing assessment

This assessment involves you self-assessing your prescribing against specific proficiencies that are felt to be essential for any trainee to achieve before finishing his or her training. You will review your prescriptions against six prescribing errors. Prior to the assessment your supervisor will also have reviewed your evaluation. Reflecting on errors identified in your prescribing, both during your assessment and through discussion with your supervisor, will enable a learning plan to be put in place in order to improve prescribing in the future.

Clinical supervisor's report

The Clinical Supervisor's Report (CSR) is a structured report of your clinical ability and gives you observational information on your performance. The GP capabilities are assessed and commented on by your supervisor. This report is completed by clinical supervisors in both hospital and non-primary care posts, as well as GP trainers in general practice.

Standard setting

In order 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. Guidance for satisfactory progression at ARCP panels has been written by the Committee of General Practice Education Directors (COGPED) and is supported by the RCGP. This is available on the MRCGP information for deaneries, supervisors and trainers page.

Evidence of progression

The general practice training programme differs from other specialty training programmes because of the 3-year duration of the programme, much of which is delivered outside the general practice environment. During training in ST1–3, the progress of the GP Specialty Trainee (GPST) is regularly monitored and guidance is provided on the anticipated trajectory. This is reviewed by the educational supervisor and assessed through the ARCP process, leading to a judgement on a trainee's progress during the time period under review. The GPST ePortfolio acts as a repository for evidence collected by a GPST to allow demonstration of this progression. It is also the source of the global evidence considered by the ARCP panel for the award of outcomes and to make a recommendation for a CCT.

The RCGP has developed comprehensive guidance on what evidence a GPST and his or her educational supervisor could provide to ensure satisfactory progress and ultimately capability for award of a CCT. Descriptors (known as 'word pictures') have been developed to provide guidance on the behaviours that a trainee is expected to develop to display the required level of capability for a CCT, including indicators of under-performance and indicators of excellence. These descriptors have been explicitly mapped to the generic professional capabilities and are included in the document under each Area of Capability.

The ARCP review at the end of the ST1 and ST2 years is the process by which judgements are made on the readiness of a trainee to progress within training (particularly at ST2 into ST3), but the only summatively assessed 'progression point' occurs at the end of ST3, prior to the award of a CCT. This requires completion of all of the required MRCGP assessments, a satisfactory educational supervisor's report and a satisfactory final ARCP review.

Progression points

The ESR rates trainees against the 13 capabilities, using the ratings of 'needing further development', 'competent for licensing' and 'excellent'. Needing further development is subdivided into:

  • below expectations
  • meets expectations
  • above expectations

Trainees are not rated as competent until they are finishing training, so a trainee needing further development is not seen as someone who is failing but as someone who has not completed the GP training programme. Trainees who are rated as 'needing further development, below expectations' will raise concerns at their next ARCP panel, whereas trainees rated as 'needing further development, meeting or above expectations' do not raise concerns. The progression points use the same terminology to support continuity.

The ST2 progression point is titled as 'needing further development' to recognise that trainees are still within the training programme. To progress, trainees need to be rated as needing further development at either the meeting or the above expectations level in their ESR.

The progression point for ST3 is titled as 'competent' as this relates to trainees finishing training and who have been assessed as competent for licensing and independent practice.

GPs in training (and their supervisors) receive structured feedback from a wide range of sources and using a range of methodologies during the GP training and assessment programme. This includes formative learning tools and reviews of learning log entries in the WPBA, PDP meetings and educational supervisor reviews. More details of these are given below.

During clinical placements, the clinical supervisor provides formative assessment and structured feedback, both informally and formally, using structured assessment tools such as CbD, COT, miniCEX, problem and random case analysis, clinical audit and significant/learning event analysis. Structured feedback is also received from patients and colleagues using tools including the MSF tool in ST1 and ST2 (and a new Leadership MSF in ST3) and the PSQ. The results of these are discussed with the trainee and inform the next PDP.

The requirements that must be met at the completion of the ST2 and ST3 stages of training are made explicit in the progression point descriptors.

Learning log

Log entries should be reflective, demonstrating personal insight into performance and learning from everyday experiences. A good, reflective log entry will show some evidence of critical thinking and analysis, self-awareness and openness and honesty about performance, along with some consideration of feelings, and, ultimately, evidence of learning, appropriately describing what needs to be learned, why and how.

Learning log entries are now linked in the ePortfolio to clinical evidence groups that map to the curriculum and the capabilities. Trainees reflect on the relevant group and capability within their entry. Educational supervisors can deselect either the group or the capability if they feel that it is inappropriate. Entries are 'shared' and can then be read and commented on by the clinical or educational supervisor. This is a powerful method of providing relevant and timely feedback on real learning in the workplace. These log entries also contribute to the evidence available to ARCP panels when they come to take a view on training progression.

The personal development plan

The PDP area in the portfolio is designed to ensure that trainees are able to demonstrate that they can assess their learning needs, plan actions to meet these needs and review their achievement of these actions, with supporting evidence.

As part of the ESR process, in addition to completing the self-assessment section, trainees will be required to create at least one PDP to cover their next review period or post. The educational supervisor will review all PDPs created in the last review period and may help edit them to make them Specific, Measurable, Attainable, Realistic (and Relevant) and Time-bound, or advise trainees to add further entries to cover missed or future learning needs, if appropriate. PDPs should continue to be created throughout the training post, and progress on those created in the last review is assessed and recorded.

Educational supervisor's review

The ESR provides feedback on overall progress and identifies areas where there is a need for more focused training. Reviews are informed by the evidence collected through the WPBA tools, along with 'naturally occurring evidence' from elsewhere in the Trainee ePortfolio (e.g. the learning log).

Trainees will meet their educational supervisor annually (currently every 6 months) to review the evidence collected against the 13 areas of professional capabilities. Trainees are required to complete a self-assessment prior to the meeting, which allows them to reflect on their progress against the expected progression in training and their needs for further development. There are minimum standards setting out the amount of evidence required, and guidelines on how often each WPBA tool should be used, to ensure that there is sufficient evidence at the point of each 6-monthly review.

As part of this meeting, detailed feedback is provided based on the evidence for all competencies, and a learning plan covering the next review period is formulated. The educational supervisor also decides whether progress is satisfactory, unsatisfactory or needs to be referred to the ARCP panel.

The educational supervisor process and meeting will mirror the process used for post-CCT GPs. The trainee will be expected to propose PDP areas for the next 6 months (or year if they are approaching the CCT and their next appraisal will be as a qualified GP).

Annual review of competence progression

Each trainee will have an ESR annually, which, through the ARCP process, leads to the annual review of their progression.

The way in which ARCP processes are organised may vary between deanery/local education training boards and regions, but the underlying principles are regulated by the Gold Guide to Specialty Training and are applied consistently. The trainee evidence is assessed by the educational supervisor, who makes a recommendation of either satisfactory or unsatisfactory progress in training. This evidence is reviewed by the ARCP panel and a statutory outcome provided. Any trainee who is deemed to be making unsatisfactory progress is offered a face-to-face interview and a remedial 'educational prescription' is recommended.

General Medical Council national training survey

All trainees 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.

In some areas, feedback is also obtained through an additional survey. For example, in England, Health Education England conduct a Job Evaluation Survey of Trainees (JEST) and, in Scotland, NHS Education for Scotland carries out the Scottish Trainee Survey (STS). These surveys provide similar data to the NTS but are more specifically targeted locally.

Examination feedback

All trainees who undertake MRCGP AKT and CSA examinations are provided with feedback on their performance to help them understand or interpret a pass/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 ePortfolio. For the AKT, trainees receive a breakdown of their marks under the three broad categories of clinical medicine, evidence interpretation and organisational questions. For the CSA, this is done using a results grid. Trainees are shown marks for each domain (data gathering and interpretation; clinical management; interpersonal skills) within every case, including generic 'feedback statements' on failed domains that the examiner for a particular case has thought relevant to a candidate's performance.

Explanations of the feedback statements, with suggested learning strategies, can be seen in the ePortfolio. This feedback is intended for discussion with the educational supervisor or trainer, in the context of overall performance. CSA 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 the issue of candidate feedback under constant review to try to make this as useful as possible to trainees and supervisors, while acknowledging the constraints imposed by a summative examination and the need for item and case confidentiality.

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Next: Flexibility and interdependency with curricula of other specialties and professions >

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