The Royal College of General Practitioners (RCGP) curriculum outlines the attitudes and competencies consistent with independent practice as a GP in the United Kingdom. It forms the educational framework for specialty training in general practice.
Specialty training in general practice is a three-year programme (ST1, ST2 and ST3). A minimum of eighteen months is allocated to general practice placements. These equip trainees with broad and fundamental generalist experience. Additionally, there are hospital placements that are selected to provide exposure to cases encountered as a GP and reflect capabilities applicable to GPs’ roles and usual working environments.
Hospital placements provide concentrated experience in specialist areas – for example, recognising critically ill children – in less time than is possible in primary care settings. Trainees acquire familiarity with the patient experience from presentation to discharge and new perspectives on the organisation of multidisciplinary teams.
A very wide range of secondary care settings are suitable for GP training. For example, experience in services for infants, children and young people may be gained by placements in hospital and community paediatric clinics or children’s centres, and experience in services for frail and elderly people may be gained by placements in gerontology or dementia units.
Later stages of training feature a more generalist clinical environment. This requires the transfer of skills acquired in secondary care, where patients are often streamed so that some diseases are more prevalent, to the wide-ranging cases that present to general practice.
Consequently, trainees must engage in reflection throughout training, including recognising the applicability of what has been learned to general practice.
Learning general practice
The workplace is the key learning environment. Training practice forms the basis of career-long development as a GP. Initially, trainees conduct consultations in coordination with their GP trainer or clinical supervisor.
This facilitates development of a safe and competent approach to clinical assessment and management and ensures patient safety under the reduced direct supervision that is characteristic of later training. Being observed, receiving feedback, and reflecting are important to this workplace-based learning.
Trainees also receive individually tailored teaching from their GP trainers and must familiarise themselves with the operation of general practices as businesses, including monitoring the quality, safety, and effectiveness of care.
GP training reflects multidisciplinary primary care as trainees are also taught by other professionals, for example, practice nurses, pharmacists, and administrative colleagues. They may undertake short attachments with these other team members. It is also beneficial to spend some time in other environments, for example, social care or voluntary organisations.
It is recommended that one half-day per week is allocated to self-directed learning. For example, trainees may attend clinics, read, complete eLearning courses, prepare for examinations or prepare their portfolio for assessment. Resources available for personal study include books, journals, and online material, for example, RCGP eLearning courses.
Subject to satisfactory progression, it is possible to undertake some training in an area of particular interest. However, this should not detract from study of the RCGP curriculum. Another way in which training is facilitated is whole or half-day release courses that enable trainees from different stages of training to gather in small groups, for example, to prepare for examinations.
Additionally, there are many regionally and nationally organised learning resources. These comprise examination preparation courses, clinical topic courses and RCGP events, for example, the annual conference.
The intended learning outcomes of the RCGP curriculum are divided into five Areas of Capability; there are thirteen subdivisions into specific capabilities (Table 1). These form the core of the RCGP curriculum and run as developmental threads throughout training.
Table 1 – Areas of Capability
Area of Capability
Specific capabilities for general practice
Knowing yourself and relating to others
Fitness to practice
Maintaining an ethical approach
Communication and consultation
Applying clinical knowledge and skill
Data gathering and interpretation
Clinical examination and procedural skills
Managing complex and long-term care
Managing medical complexity
Working with colleagues and in teams
Working well in organisations and systems of care
Improving performance, learning, and teaching
Organisational management and leadership
Caring for the whole person and the wider community
Practising holistically, promoting health, and safeguarding
The RCGP publishes topic guides that apply specific capabilities in clinical or professional contexts. The Professional, Life Stages, and Clinical topic guides illustrate key learning points with case scenarios, reflective questions, and tips for learning and teaching.
They also highlight the skills required for each area of practice and give examples of how these may be assessed. The Professional topic guides are on consulting in general practice; equality, diversity, and inclusion; evidence-based practice, research and sharing knowledge; improving quality, safety, and prescribing; leadership and management; and urgent and unscheduled care.
The Life Stage topic guides are on children and young people, reproductive health and maternity, people living with long-term conditions including cancer, older adults, and people at the end of life. The Clinical topic guides are listed in Box 1. The topic guides are not an exhaustive list of the learning requirements to become a GP.
Box 1 – Clinical topic guides
The principal trainers in GP training are clinical supervisors on placements and the educational supervisor (GP trainer). In addition to the acquisition of skills, these relationships allow trainees to assimilate vocational language, behaviours, and philosophy.
The role of clinical supervisors is daily supervision in clinical settings. They provide teaching, developmental conversations and regular feedback and are first-line contacts for any issues. GP trainers assume responsibility for monitoring trainees’ clinical and educational progress.
They review the ePortfolio learning log and provide feedback on reflective practice, assess formal evidence of learning – for example, the clinical supervisor’s review and patient and colleague feedback – against RCGP curriculum competencies and meet the trainee biannually to review the evidence against the thirteen specific capabilities and make recommendations on training progress.
The Membership of the Royal College of General Practitioners (MRCGP) is an integrated assessment system that confirms that a doctor has completed specialty training in general practice and possesses competencies consistent of independent practice in the UK. Successful completion is requisite to being awarded a Certificate of Completion of Training (CCT).
The three parts of the MRCGP are Applied Knowledge Test (AKT), Clinical Skills Assessment (CSA) and Workplace-Based Assessment (WPBA). The AKT is attempted in ST2 or later. It is a computer-based assessment – comprising 200 questions – on the knowledge that underpins independent general practice in the UK.
The CSA tests a doctor’s ability to integrate and apply clinical, professional, communication and practical competencies relevant to general practice. It is attempted in ST3 and features thirteen simulations of GP consultations that cover a range of cases from across the RCGP curriculum.
The WPBA assesses day-to-day performance using real experiences as evidence for learning in the thirteen specific capabilities. Evidence is recorded in the learning log and comprises specific assessments and reports, documentation of naturally occurring evidence and compulsory requirements, for example, child safeguarding and basic life support training certificates. Examples of learning logs are available on the RCGP website.
Many specific assessments constitute the WPBA, including Case-based Discussion, Clinical Evaluation Exercise, Patient Satisfaction Questionnaire, and Quality Improvement Project. This evidence is used to guide biannual reviews and – at the end of training – decisions regarding readiness for independent practice.
At the conclusion of each year of specialty training in general practice, there is an Annual Review of Competence Progression (ARCP). This is an evaluation of trainees’ readiness to progress in training. At the end of ST3, completion of all components of the MRCGP and a satisfactory GP trainer’s report is required alongside a final ARCP for the issue of a CCT.