Training Home Page

About Frimley VTS

Foundation Programme

Hospital-Based Trainees

Practice-Based Trainees

Frimley Trainers Group

Course Organisers

MRCGP & E-portfolios

MRCGP Exam
You must familiarise yourself with the RCGP website and keep a regular eye on developments. The MRCGP exam has now three components:

1.       Applied Knowledge Test (AKT)
MCQ & EMQ examination, three sittings every year, cost £360 (2007)
Content of exam reflects learning in all years and we do not advise taking this before ST3  

2.       Clinical Skills Assessment (CSA)
OSCE / simulated surgery examination, three sittings every year, cost £1260
Taking this component before the mid-point of  ST3 is highly likely to be a waste of money 

3.       Workplace Based Assessment (WPBA)
“The evaluation of a doctor’s progress in their performance over time”
Recorded over three years in a logbook, the e-portfolio. Costs £200 to register and £200 per year.
Reviewed regularly by your Educational Supervisor and annually (and ultimately signed off by) the Deanery
Your e-portfolio is the record of your WPBA and it is the e-portfolio that will be used to decide pass or fail in this element of the MRCGP examination

E-Portfolios

The e-portfolio develops over the three years and accumulates the evidence for the WPBA
         ·     Trainee records:     Personal development plan
                                           Learning log of educational activity, mapped to the curriculum areas
                                           Progress in skills log (as recorded in DOPS)

         ·     Other contribute:    Assessments (evidence) Mini-CEX, CbD, MSF, DOPS
                                          Clinical Supervisor Reports
                                          Educational Supervisor 6-month Reviews

Ultimately, it should demonstrate:

1. Educational activity across all areas of the curriculum (via the learning log)
2. Competence in all the essential skills (via the skills log)
3. Satisfactory completion of hospital training (via the Clinical Supervisor's Reports)
4. Competence in the domains of competence - signed off by the ES using evidence mainly from assessments in ST3

This guide gives some advice about how to put your e-portfolio together. In particular, it gives detailed advice about how to complete your learning log.

Download    - Building Your E-portfolio

Domains of Competence

To complete the WPBA, the RCGP requires your ES to sign-off competence in 12 areas (domains) by the end of year three. You will note that in your e-portfolio, the assessments are called "evidence", because it is these assessments that will be used by your ES in this process. CbD's should be marked using these domains of competence. In addition, the CS will rate each trainee in these domains of competence as part of the Clinical Supervisor's Report at the end of each post. These areas are:

A simple explanation of these terms is included in the Clinical Supervisor's Report. A more detailed description is available on the RCGP website. Your ES will complete a formal report on progress in these domains of competence as part of the six-month "nodal reviews".

Download    - Clinical Supervisors Report
                  - Detailed Descriptors for Domains of Competence  

Assessments

All the assessments must be completed on-line. The forms above are for information only

ST1 and ST2
   Two CbD and two mini-CEX per 4 month post (complete six of each by month 10)
   DOPS where relevant to the post
   Two MSF in ST1 (post 2 and post 3)

ST3
   Twelve CbD and twelve COT
   DOPS where relevant
   Two MSF in ST3 (months 28-30 and 30-34)

Download - Overview of educational structure & reviews

What are CbD about?

Case-based discussion (CbD) is a structured interview designed to explore professional judgment exercised in clinical cases which have been selected by the Trainee and presented for evaluation. Evidence collected through CbD interviews will support the judgments made about trainees at the interim and final reviews throughout the entire programme of GP training.

The Trainee is responsible for selecting cases, organising the CbD, ensuring the paperwork is completed.
The trainee should ensure that a balance of cases are represented including those involving children, mental health, cancer/palliative care and older adults, across varying contexts i.e. surgery, home visits and out-of-hours contacts.
For each CbD, the trainee will select two cases and present copies of the clinical entries and relevant records to the assessor one week before the discussion.
The assessor selects one of the cases for discussion.
The assessor should decide on several questions to ask ahead of the CbD and should select questions that challenge the Trainee in the “competency areas” from the GP Curriculum. Descriptions of what these areas refer to are found on the Clinical Supervisors Report and "Domains of Competence".  There is also a list of sample questions

IN ST1 and ST2 these assessments are best done by the Clinical Supervisor and not by a deputy

Estimated time required: 30 minutes (20 min for assessment, 10 min for feedback)  

Download - Sample questions to use in CbD
               - Sheet for preparation & notes

Notes for Trainer:
This is a variation on a coffee break discussion.
Make sure that you are given a choice of cases and you can use either 1 or 2 cases depending on time taken. 
Look at your annotated checklist of "Domains of Competence" to pick 1-2 descriptors under each domain that you would like to try and cover. 
Construct a question for each of these identified descriptors. 
Consider videoing the CbD to allow you to recheck what the trainee said (for your own use only - not a requirement)

What are mini-CEX and COT about?

Mini-CEX is a 15 minute snapshot of doctor/patient interaction, within a secondary care setting. It is designed to assess the clinical skills, attitudes and behaviours of trainees essential to providing high quality care.

Trainees will be asked to undertake six observed encounters during 12 months, with a different observer for each encounter. Each of these encounters should represent a different clinical problem and trainees should sample from a wide range of problem groups within the year.

Immediate feedback will be provided after each encounter, by the observer rating the trainee. Trainers and trainees will need to identify and agree strengths, areas for development and an action plan for each encounter.

Assessors: These may be staff grades, experienced specialty registrars (ST3 or above) or consultants.

Estimated time required: 20 minutes (15 min for assessment, 5 min for feedback)

Download - List of Performance Criteria for COT
               - Marking grid for COT
               - Consent form

Notes for Trainer:
This is old MRCGP video recordings and effectively makes you the marker of their MRCGP video
The current COT performance criteria are identical to the old MRCGP video criteria
This means that they do not match 100% with descriptors in the Competence Checklist but you can find most of them in the first 5 domains of competence
You should ensure that you use COT to "tick boxes" on your Competence Checklist as well as looking for the performance criteria
Video recordings should be kept for FIVE years

What are DOPS about?

DOPS is designed to provide feedback on procedural skills essential to the provision of good clinical care.  The mandatory procedures chosen have been selected as sufficiently important and/or technically demanding to warrant specific assessment. Trainees will be asked to undertake observed encounters during the three years with a different observer for each encounter. Each DOPS should represent a different procedure. The registrar chooses the timing, procedure and observer. ST’s many be requested to repeat DOPS assessment of Foundation procedural skills. Please note that there is currently (July 07) contradiction between the e-portfolio list and RCGP website list – I am sure that this be resolved soon…

There are 8 mandatory procedures to be covered:

There are 9 optional procedures which should be recorded, if undertaken:

In addition, all ST’s are expected to have competence in all the areas of the Foundation Programme and they may be asked to demonstrate competence in these skills also.

Assessors:        Experienced SpRs, staff grades, appropriate nursing staff or consultants in a secondary care setting, or the GP trainer, appropriate nurses or other GPs in a primary care setting.

Number of assessments: One for each procedure, for at least the mandatory procedures

Estimated time required: 10 - 20 minutes (5 - 15 min for assessment, 5 min for feedback)

Notes for Trainer:
The trainee may accumulate several DOPS for the same procedure
If several DOPS exist for a single procedure, the trainee them self amends the overall rating in their e-portfolio to reflect the collective results 
It is clear that the trainee will be using their record of "Optional Procedures" DOPS as their record of training and competence in minor surgery
Don't worry about signing off Foundation Programme skills

What are MSF about?

The MSF provides a sample of attitudes and opinions of colleagues on the clinical performance and professional behaviour of the trainee) and helps to provide data for reflection on performance and gives useful feedback for self-evaluation. It must be completed via email. Results are collated centrally and sent to the trainee.

During ST1  months 5 or 6 and then 2 to 4 months later;
     5 clinicians completing both questions.

During ST3 months 28 or 29 or 30 and then 2 to 4 months later; 
     5 clinicians completing both questions and 5 non-clinicians completing question 1.

Notes for Trainer:
The RCGP page contains full details on how to complete the MSF. 
October 2007 - the explanatory letter that is given to assessors is not yet available
The RCGP site explains how to access & complete the forms 
The RCGP site explains how to use this information in feedback to the trainee
The two questions are:
   1. Please provide your assessment of this doctor's overall professional behaviour
   2. Please provide your assessment of this doctor's overall clinical performance

What is the PSQ about?

The PSQ provides useful feedback to doctors by providing a measure of the patients’ opinion of the doctor’s relationship and empathy during a consultation.  The evidence provided is useful in helping trainer and trainee to address needs and facilitate educational shift during the training period.

The PSQ takes place in ST3 months 31-34
If the trainee has a primary care placement in ST1 or ST2, an additional PSQ is undertaken

Notes for Trainer:
Trainee and trainer decide a date for the PSQ and a date to discuss the results
Questionnaires are given to 40 consecutive patients
The results are collated in-house and the result is entered onto the e-portfolio
The meeting to discuss results is entered into the e-portfolio as a "professional conversation"October 2007 - the questionnaire that is given to patients is not yet available