GP trainees are required to pass MRCGP examination in order to obtain a Certificate of Completion of Training (CCT). MRCGP examination consists of 3 components: Applied Knowledge Test (AKT), Clinical Skills Assessment (CSA) and Workplace Based Assessment (WBPA).
Current information and guidance about the examination can be found on the RCGP website.
The Applied Knowledge Test (AKT)
The AKT tests the application of clinical knowledge rather than just the recall of factual information.
The exam consists of 80% clinical, 10% interpretation of statistics and 10% primary care administration including medico-legal/ethical questions.
AKT dates for 2015-16 can be found here: AKT 2015-16
Preparing for the Applied Knowledge Test (AKT)
There is no better way to prepare other than by making use of day-to-day clinical encounters. Follow up your PUNs and DENs with interest and summarise relevant national guidance.
You need to put in some dedicated preparation time, focus on your identified areas of clinical need, brush up on medical statistics and make use of the many available published revision books and on-line resources to practice answering questions and identify further areas of unmet need.
- The RCGP publish a small sample set of questions on their website.
- It is wise to read the AKT content guide which is published by the RCGP regularly.
- RCGP e-learning resource is freely accessible to all AITs and now includes several Essential Knowledge Challenges with associated up to date Essential Knowledge Update modules. Many AITs are finding this excellent preparation for the AKT.
- Wessex AITs are funded for most of the cost of attending a 1-day AKT preparation course run by the Wessex Faculty of the RCGP. Further information is available on the Deanery website.
When should I take the Applied Knowledge Test?
Clearly this is dependant on your own confidence, organisational skills and personal situation but it is becoming increasingly clear that the second half of a standard ST2 year is a good time to sit the AKT. The pass rates for first-time ST2 takers in the May diet of the exam are as good as first-time ST3 takers in the October sitting and it can therefore mean one hurdle is removed from the busy ST3 year. Initial concerns that ST2s would not have had primary care experience are no longer valid now that ST1s and ST2s all get a GP placement.
If you are uncertain whether this is the right time for you why not discuss this with your Educational Supervisor?
If you have decided to apply for the May sitting then ensure you apply early enough!
Just as a reminder about eligibility for the AKT:
- ST2, ST3, GP Refresher trainees
- maximum of 4x attempts – applicable to those starting in specialist training in August 2010 for the AKT, unlimited number of attempts for those who started training before this time.
- must be within their training period. At the discretion of the RCGP and deanery, and in exceptional circumstances only, one attempt at the AKT will normally be permitted in the six month period immediately following exit from training without receiving a CCT. Please send a support letter of approval to the Exams department if this is the case.
For general AKT information and application please consult the AKT section of the RCGP website. There are some very helpful resources which have been produced to guide candidates in how to prepare for the AKT.
The Clinical Skills Assessment (CSA)
The clinical skills assessment (CSA) assesses how a doctor integrates the application of clinical, professional, communication and practical skills. The CSA feels like a busy morning surgery with thirteen ten-minute consultations. Candidates stay in individual consulting rooms whilst different assessors observe consultations with standardised “patients”, all expertly role-played by professional simulators. The examination is held at the RCGP headquarters in Euston Square, London.
Case Cards are a useful resource for preparing for the CSA exam. They are available via the College.
The Dorset GP Centre has Case Cards available should you wish to look at them before purchasing.
Past experience has shown that regular practice with a group of fellow-ST3s is the most successful strategy for passing CSA.
Support for trainees struggling with CSA
GP trainees in Dorset have a good record of success in passing the CSA but each year there are a small number of trainees who struggle to pass the examination. We are keen to identify trainees who might encounter difficulties as early as possible. There is a correlation between low scores in the GP recruitment process (both at stage 2 and stage 3 of the National Recruitment process) and subsequent failure of the CSA examination. ST1 trainees who scored in the lowest 10% of recruitment scores are pro-actively identified and offered additional support. This may be at Dorset patch level or at the Deanery level, alongside trainees from across Wessex. Trainees are strongly encouraged to talk to their Programme Directors as early as possible in their training programme if they have concerns about their communication skills or if their trainer/educational supervisor has raised concerns.
There are many other sources of help and support available to trainees who are struggling with the CSA. These include support from an experienced linguist; advanced communication skills training from a professional drama coach and one-to-one support from the Programme Director team. The Wessex Deanery has a range of expertise available to support trainees and doctors in difficulty and this is available from the Professional Support Unit.
- The Clinical Skills Assessment (CSA) from the viewpoint of an AIT
- The Clinical Skills Assessment (CSA) from the viewpoint of a GP Educator
- CSA Workbook – a helpful resource of practice cases
Workplace Based Assessment (WBPA)
WBPA is an important component of MRCGP. You will be required to keep an ongoing electronic learning log and complete a number of compulsory assessments. The RCGP website contains up to date information about the current requirements and guidance about the assessment tools.
All GP trainees have an Annual Review of Competence Progression. Please see the Deanery website for more information about this process.
Obtaining Your CCT
Candidates who successfully pass MRCGP can apply for Certificate of Completion of Training. The Wessex Deanery will confirm that training has been successfully completed and then confirm this to the RCGP. The RCGP then makes a recommendation for CCT to the GMC. The GMC grants applicants entry onto the GP Register.
For information about non-standard training schemes (e.g. Certificate of Eligibility for GP Registration through specialty equivalence) please see the GMC website.
CCT & National Performers List
Once you have secured a post on completion of your training, you will need to change your status on the National Performers List (NPL). If you are moving to another Area Team to take up your new post, until you have changed your status on the National Performers List, you will be unable to work as an independent GP post completion of training.
In order to minimise the delay in the processing of your transfer of status on the NPL, it is recommended that the transfer of status is processed by the Area Team where the trainee has completed their training, irrespective of where you are going to work.
If you are moving to another Area Team, you will have to submit a further notification of change form to the new Area Team once your change of status to locum has been approved. Whilst this will mean completing 2 forms of notification, you will be able to move straight into independent clinical practice work upon completion of training.
All trainees should complete a notification of change form which should be submitted to the Primary Care Support Office for the Area Team where they have completed their training.
Trainees should be asked to submit a copy of their CCT together with a letter of clinical reference from their trainer which will be their trainer’s educational supervisors report.
For trainees remaining in the same Area Team they should note on the change of notification form the capacity in which they will be working post traineeship.
For trainees moving to another Area Team they should indicate on the form that they will be working in the capacity of a locum doctor. These trainees can then in due course complete a further form for submission to the Primary Care Support Office of the Area Team where they will be relocating. On this form they should indicate they are currently on the national performer list as a locum and inform in what capacity they will be working in the new area.
Area Teams should ensure procedures are in place to process these notifications with minimum delay and write to the trainees confirming their status of inclusion in the National Medical Performer List.