nMRCGP

1
nMRCGP

• Dr Mark Metcalfe

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nMRCGP

• Money
• AKT
• CSA

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Money

• Become AiT 492
• AKT 360
• CSA 1260
• Fee to PMETB 780
• TOTAL 2892
• Course 660
• TOTAL 3552

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Money

• If you have to retake your exams.
• 5282
• These are figures for this year.
• They might increase

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Registrar pay

• Basic salary 30660
• plus 50 15330
• London weighting 2162
• TOTAL 48152

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Exams

• AKT
• Computer marked multiple choice paper
• CSA
• Practical assessment of consulting skills

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AKT

• Relevance
• The AKT should be relevant to general practice
  any topic covered can be one which occurs
  commonly or one which is significant but less
  common
• High prevalence Low impact e.g. URTI
• High impact Low prevalence e.g. meningitis
• Topical e.g. Controlled drugs

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Sources

• Clinical Evidence
• Cochrane Database
• BNF
• GP Curriculum
• NICE
• SIGN
• BMJ Review articles original papers
• BJGP
• DTB

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This is your friend
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AKT

• Core clinical medicine and its application to
  problem solving in a general practice context
• 80 of items
• Critical appraisal and evidence based clinical
  practice
• 10 of items
• Ethical and legal issues as well as the
  organisational structures that support UK general
  practice
• 10 of items

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Stuff no one bothers with but features heavily in
the exam

• Regulatory frameworks
• Legal aspects, e.g. DVLA
• Social services, e.g. Certification
• Professional regulation, e.g. GMC
• Business aspects, e.g. GP contract
• Prescribing, e.g. Controlled drugs
• Appropriate use of resources, e.g. drugs
• Health Safety, e.g. needlestick injury
• Ethical, e.g. Mental capacity, consent

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Essentials for AKT

• Know latest guidelines
• Know the BNF
• Know basic stats
• Your core medical knowledge is probably already
  sufficient.

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AKT

• 1164 candidates
• Mean score 76.5
• Pass mark 69.85
• Pass rate 83.7
• Pass rate ST2 76
• Pass rate ST3 88

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AKT Areas of weakness

• Asthma
• COPD
• Certification
• Travel health (vaccinations and commonly used
  drugs)
• Management of dermatological problems
• National screening programs

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CSA

• You must bring
• BNF, Stethoscope, Ophthalmoscope, Auroscope,
  Thermometer, Patella hammer, Sphygmomanometer
  (aneroid or electronic), Tape measure, Peak flow
  meter and disposable mouthpieces
• There are no spares at the exam centre
• Anything else you need is provided

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CSA

• You have your own room.
• You have a list of patients your surgery for
  the morning.
• The list contains brief info about the patient.
• It may or may not include PMH, drugs etc.
• You probably wont know why they are coming.
• You have never seen the patient before but
  colleagues might have.

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CSA

• Buzzer will sound and patient and examiner come
  in.
• You have 10mins after which buzzer will sound
  again. Anything said or done after this will not
  count. The patient and examiner then leave.
• There is no 1min/2min warning buzzer.
• There is a 2 minute break between patients.
• There is a 15min break after 7 patients seen.

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CSA

• The examiner sits out of your line of site.
• Examiner does not participate in the
  consultation. Ignore them.
• All patients are played by actors who have been
  well briefed beforehand
• They will almost certainly not have any physical
  signs to elicit on examination

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CSA Exams and investigations

• If you want to examine the patient say so and say
  what you are going to examine.
• If they are testing this exam technique they will
  let you go ahead.
• They will then give you the exam findings.
• If they are not testing this exam they will just
  give you the findings and tell you not to
  examine.
• They will only give you results of exams you say
  you will do.

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CSA Exams and investigations

• Examination is what you would normally do as a
  GP.
• This means a lot of it can be done with the
  patient sitting in the chair.
• It does not have to be exhaustive.
• Eg. Chest exam percussion and auscultation is
  fine.

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CSA Exams and investigations

• Any investigation results will be on the table in
  front of you or, more likely, will be brought in
  by the patient.
• It will list normal levels so you dont have to
  remember them.
• Abnormal findings will be common GP tests.
• Eg. Hb, HbA1c, urinalysis etc.
• It will not be anything obscure.

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CSA Management plans

• If you want to prescribe a drug you dont have to
  write a prescription
• All you need do is say
• Eg. I will give you omeprazole 20mg once a day.
• This is as good as having written it.
• There are prescription pads on the table. Do not
  let these distract you.

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CSA Management plans

• DONT WRITE ANYTHING DOWN
• There is no time
• The prescription will be marked
• There is no penalty for just saying it
• You have to say what you are giving anyway

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CSA Management plans

• The same applies for blood tests and sick notes
  and any other forms you might write.
• Just say what you will do.
• If you want to make a referral, ask the patient
  to wait in the waiting room and you will bring
  the letter/form out to them.
• Leaflets can be collected from reception

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CSA

• You have 10 minutes per case.
• Shows poor time management is a reason they can
  fail you at the station.
• And they will.
• You MUST be consulting at 10 minutes.

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CSA

• Each case is marked in 3 domains
• Data gathering, examination and clinical
  assessment skills
• Clinical management skills
• Interpersonal skills
• All domains have equal weighting
• Do not spend 8 minutes on history and examination
  you will fail the station.

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CSA

• But those domains have no meaning
• What are they actually looking for?

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CSA

• DATA-GATHERING, TECHNICAL ASSESSMENT SKILLS
• Gathering using data for clinical judgement
• Choice of examination
• Investigations their interpretation
• Demonstrating proficiency in performing physical
  examinations using diagnostic and therapeutic
  instruments

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CSA

• CLINICAL MANAGEMENT SKILLS
• Recognition management of common medical
  conditions in primary care
• Demonstrating a structured flexible approach to
  decision-making.
• Demonstrating the ability to deal with multiple
  complaints and co-morbidity.
• Demonstrating the ability to promote a positive
  approach to health

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CSA

• INTERPERSONAL SKILLS
• Demonstrating the use of recognised communication
  techniques to gain understanding of the patient's
  illness experience and develop a shared approach
  to managing problems.
• Practising ethically with respect for equality
  diversity issues, in line with the accepted codes
  of professional conduct.

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CSA

• The grades will be on a four point scale
• Clear Pass
• Marginal Pass
• Marginal Fail
• Clear Fail
• There are no merits or grades at the end for
  the exam as a whole.
• You pass or fail.

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I Failed?
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Data Gathering

• Disorganised and unsystematic in gathering
  information from history taking, examination and
  investigation
• Does not identify abnormal findings or results or
  fails to recognise their implications
• Data gathering does not appear to be guided by
  the probabilities of disease
• Does not undertake physical examination
  competently, or use instruments proficiently

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Clinical management

• Does not make appropriate diagnosis
• Does not develop a management plan (including
  prescribing and referral) that is appropriate and
  in line with current best practice.
• Follow-up arrangements and safety netting are
  inadequate
• Does not demonstrate an awareness of management
  of risk, and health promotion

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Interpersonal skills

• Does not identify patients agenda, health
  beliefs preferences / does not make use of
  verbal non-verbal cues
• Does not develop a shared management plan or
  clarify the roles of doctor and patient
• Does not use explanations that are relevant and
  understandable to the patient
• Does not show sensitivity for the patients
  feelings in all aspects of the consultation
  including physical examination

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Global

• Disorganised / unstructured consultation
• Does not recognise the challenge (e.g. the
  patients problem, ethical dilemma etc.)
• Shows poor time management
• Shows inappropriate doctor - centeredness

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Essentials for CSA

• Be in general practice for a few months
• Consult at ten minutes