The recent thread on summative assessment has thrown up the usual MRCGP exam
is the best thing since sliced bread / is the worst thing since Man City got
relegated (well the time before last season anyhow) arguments, as well as
highlighting the current difficulties in measuring competence / excellence
/fitness to practice etc.

One thing that has been lacking from the debate is a realistaion that the
College have now defined competence explicitly, and introduced it into the
MRCGP exam through the "assessment of consultation skills" otherwise known
as the video component.  This, as far as I can tell is a responce to
criticisns from other Royal Colleges etc that there is no clinical
component.  The ideal assessment may be an observer observing each candidate
over a period of some days in the real world.  The inpracticality of this
has led to this compromise situation which now faces candidates.  They (as
from this sitting of the exam) have to produce a videotape of 20-24
consultations on which the presence or absence of 11 mandatory criteria are
noted.  Each andidate only has to exhibit each criteria once during the
consultations in order to fulfil that criteria - in other words if there is
one consultation on the tape somewhere with all 11 criteria in it,
surrounded by 23 complete turkey or even dangerous consultations, the
candidate will still pass this section.  The whole video bit is either pass
or fail - competence according to their definiion is either present or
absent.  My guess is that the only candidates who will fail the video bit,
will be those who fail to fulfill all the technical specifications set down
by the college.  Furthermore the work invlved in producing the tape is
potentially enormous, and may act to the detriment of some candidates in
their prepartion and therefore success of the written and oral sections of
the exam.

In summary, whilst I applaud these initial attempts to intorduce a clinical
component into the exam, the present state of play is far from refioned and
not acting in the candidates interests - in short nothing less than a dogs
breakfast.  What the examiners will make of sitting in closed rooms
ploughing through endless tapes identifying the criteria - one can only hope
that from it emerges a system of assessment that works in the best interests
of candidates the college and the public.

Furtehrmore, the sooner that summative assessment and the college exam can
be brought together administratively the better - although I realise that we
are currently a long way off from that (for example at present candidates
preparing for summative asessment and the MRCGP can use the same videoed
consultations for both, as long as they remember to take a copy, but they
have to get patients to complete different consent forms before and after
the consultation - 4 consent forms altogether.

Just in case any of you are interested, the 11 mandatory competences are:
1. The doctor encourages the patients contribution at appropriate points in
the consultation
2. Cues that are present are not totally ignored
3. Appropriate details are elicited to place the complaint(s) in a social
and psychological context
4. Sufficient information is obtained for no serious condition to be missed
5. The physical examination chosen is likely to confirm or disprove
hypotheses which could reasonably have been formed or is designed to address
a patient+s concern
6. The doctor appears to make a clinically appropriate working diagnosis
7. Diagnosis, managemement and effects of treatment are explained
8. Content and language chosen are appropriate to what the patient needs
9. The management plan is appropriate for the working diagnosis, reflecting
a good understanding of modern accepted medical practice
10. Management options are shared with the patient
11. Doctor prescribes appropriately

Richard

Richard Neal (MRCGP!)
Research Fellow
Centre for Research in Primary Care
University of Leeds


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