Intended for healthcare professionals

Career Focus

# How to pass the MRCGP

BMJ 2004; 328 (Published 15 May 2004) Cite this as: BMJ 2004;328:s195
1. Peter Cross, freelance journalist
1. London

## Abstract

As part of our series to help you succeed in the current postgraduate royal college exams, Sabina Dosani and Peter Cross give the lowdown on the membership exam of the Royal College of General Practitioners and interview an examiner and a candidate for their tips on passing it

The MRCGP is a credit accumulation exam. Candidates must pass four modules within three years, or retake the whole exam.

The four modules are:

Firstly, a written paper

Secondly, a multiple choice paper

Thirdly, an assessment of consulting skills by one of two methods:

• Video recordings of consultations.

• “Simulated surgery,” in which a series of standardised patients are portrayed by role players. This is available only to those candidates who have insuperable difficulties making videos.

Fourthly, an oral examination.

You don't have to pass one module before sitting the next. Each module is available in summer and winter.

## Components and requirements

You can sit the exam if you are eligible to be an independent general practitioner, or if you are undergoing vocational training. This means a general practitioner registrar embarking on their vocational training is entitled to sit the MRCGP from the day they start. Most do it towards the end of training. You must provide evidence of proficiency in cardio-pulmonary resuscitation.

## How much does it cost?

£260.00 per module.

Eight per cent.

## Who writes the questions?

A panel of practising general practitioners, recruited by the college, write all questions.

## Multiple choice

The three hour MCQ has 200 items. 65% is on medicine, 15% on administration and management, and 20% on research, epidemiology, and statistics. Traditional true/false questions have been replaced with single best answers, where you have a choice of five responses arising from clinical vignettes. Extended matching questions, where clinical scenarios are followed by a number of options, are also included in the MCQ paper.

## Construct marking

For the written paper, examiners predetermine so called constructs that they look for in candidates' answers. Candidates don't know what the constructs are. However, the college website contains specimen answers, giving a good idea of the constructs they are looking for.

## Video

The video is a test of consulting skills. Examiners are looking for doctors who encourage patients' contributions, respond to cues, and elicit details, placing a complaint in a social or psychological context.

## Oral exam

This comprises two 20 minute orals conducted by two examiners, with a break of five minutes. The oral examination is structured to look at professional values underpinning decision making. Examiners are searching for evidence that candidates' decision making is rational, ethical, and sensitive. There isn't always a correct answer. Certain areas such as patient care, working with colleagues, social role of general practice, doctor's personal responsibility are favourites.

## Organiser's view

David Sales is the deputy convener of the MRCGP. “All 150 examiners are practising general practitioners. We do not trick candidates. Every question is something a jobbing general practitioner will come across. The simple reason people fail is that they are not good enough. In the written paper candidates are presented with clinical material or material relating to a drug trial and asked to integrate, evaluate, and synthesise answers. For example, in a recent paper, we presented data comparing venlafaxine and fluoxetine. Candidates were asked how drug company literature differs from a scientific paper.

“The video upsets candidates most. There is a tendency for candidates to put a list of the performance criteria up in front of them when they are consulting and just go through the tick list in a non-thinking manner. Each tape is marked by seven examiners, independent of each other, judging performances against predetermined criteria. We want active listening and open ended questions. Candidates should demonstrate that at the end of a consultation they know more about that patient than at the beginning. We also hope candidates will be able to explain a diagnosis in words of one syllable.

“In the orals we ask five questions such as: What makes an effective primary care team?', How would you communicate with the media?', How would you deal with aggressive patients?', What do you do if patients bring you a gift?', How does it make you feel?', Do you accept it?' If candidates have a superficial appreciation of ethical issues, or they can't discuss topics in depth then we start getting worried.

### The future

“We're looking at an assessment package which integrates workplace based performance. There will be a test of competence, which is going to be a knowledge test that may be machine markable. There may be an OSCE using either real patients or simulated ones. It's not firmed up yet but exams are evolving.”

## The candidate's view

Attiya Khan has just passed the MRCGP and completed her general practitioner registrar year.

“People say GP exams are easy. Compared with other postgraduate exams they have a much higher pass rate. I failed the MCQ first time. I didn't do enough book work and underestimated how hard it was

### Exam technique

“The RCGP website has practice written papers and sample answers that are useful. Go on a RCGP course. They are really expensive, but if you don't you'll find it difficult to pass. They give you questions like: Daisy Boyd, aged 69, presents to your surgery smelling of urine. What do you do?' Most people say they will do a history examination and investigations and for that get five marks out of a possible 25. The RCGP want you to say, According to this consultation framework, these are the issues for the patient, issues for the doctor, issues for the practice, and issues for society.' Ask yourself, Why has the patient come at this point? What is going on in her life?' Give a plan of the history, examination, and investigations, and what impact this has on your practice. Mention time constraints and what referral facilities you have. For Daisy Boyd you need to discuss the ageing population and her inadequate care as well as cost implications.”

### Hot topics

“In the written paper there is a section called hot topics, and you need to know the last 18 months of the BMJ, which is huge. There is a RCGP hot topics course. Four colleagues got into a group and chose a hot topic each to research and bring back to discuss. It cut the work to a quarter.”

### Video

“Trainers are not always up to date on what you need to pass. You can waste six months making videos that are useless. I wasn't told you need to have a date and time on each video.”

“I thought you just video what you normally do in daily practice but they are specific about what they want you to do and ask. They want you to share management options which is hard because doctors are used to saying, Do X, Y, and Z and come back to me.' You'll fail if you do that. You have to say, Here are the options: we can either do nothing, we could give you antibiotics, we could leave it and review you—what do you want to do?' Often older patients don't like that, they say, You're the doctor.' Many patients refuse to be videoed or have a complaint where you can't get all 15 points in.

“You end up following the RCGP pattern. At first I thought this was artificial but by the end I thought it was useful. But it doesn't work on all the patients. It works if you've got highly intelligent, motivated people to play along.”

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