Get Through MRCGP: Clinical Skills Assessment PDF

FOREWORD

When I read the first edition of this book I was impressed by the way that the authors had helped young doctors, studying to become general practitioners, understand the complexity of the consultation whilst preparing for the Clinical Skills Assessment of the MRCGP examination. The second edition builds on the delightful approach of the successful first edition with new scenarios and explanations of how to approach clinical situations in general practice and how to think holistically about patient care in first contact situations.

The book begins with an explanation of the MRCGP CSA and makes suggestions as to how best to prepare for it, throughout the year and in the days and hours before the assessment. This is followed by thirty two sections, each of which is intended to represent a station in the CSA. The scenarios cover a range of common situations encountered in general practice and offer a complete revision guide with advice on current best practice.

The authors encourage the learner to think about different settings and how they would approach the presenting problem; readers are encouraged to consider what might lie behind the presenting problem and how they might use their interpersonal skills effectively. They are also encouraged to think beyond the clinical example, reflecting on how, by changing one piece of information, a doctor might take a different approach to similar presenting symptoms. The book could be used for individual study or revision, but has been written in a way that also encourages peer learning and reflection and would be particularly useful as a basis for group study or for trainers to use with a range of learners in their practice, helping each to understand complex clinical management.

This edition continues to give insight into the thought processes of our examiners and it encourages a holistic approach to study rather than a ‘box-ticking' approach or rote learning. It approaches the CSA positively and encourages trainees to think about the domains that need to be assessed (and demonstrated) to assure the public of fitness for completion of training. This edition raises the concept of ‘red flags' and the importance or recognising less common but very significant pointers of serious conditions. I particularly liked another new concept: practising a one-minute explanation of issues encountered in the section. A simple but effective concept and one that could be used alone, video-recorded or in group learning.

I am certain that the second edition will be as popular as the first; helping trainers, their registrars and foundation trainees understand and explain the complexities of patient care in general practice.

This edition is also aimed at Family Doctors [as General Practitioners are more commonly known outside of the UK] who are preparing to undertake and pass the MRCGP [INT] examination for the country, or region of the world, where they work.

We know that, in spite of the wide variety of contexts in which Family Doctors work worldwide, differing because of the health systems, culture, epidemiology, language, history and geography, that at least two thirds of what we do is recognisably similar, while a third is locally specific. These similarities and differences are acknowledged in the differing curricula for the locally devised MRCGP [INT] examination sites in the Middle East, South Asia, South East Asia Pacific, North Africa and Europe.

In the West the ethos of patient-centred consulting has only become widely established for the past thirty years, with the international evidence for this collated in the last twenty years and then actively promoted by the World Organisation of Family Doctors [WONCA] and World Health Organisation [WHO]. The Royal College of General Practitioners successfully introduced this ethos into the UK curriculum firstly by means of establishing a video assessment of consulting skills into the MRCGP examination, which effected tremendous behavioural and cultural changes in GPs as well as more systematic analysis of the doctor-patient interaction.

Assessment can therefore drive the learning and the teaching. In a similar fashion, international pioneers of Family Medicine have developed local curricula and examinations to assess these, which the Royal College have successfully accredited with the MRCGP [INT], having similar academic rigour to the UK orientated MRCGP. These curricula have also recognised the evidence base for the emphasis on patient centred consulting and this is reflected in the various communication and clinical skills assessments that the differing MRCGP [INT] examination sites use, increasingly in the locally used language.

As this book emphasises, unless this ethos and the communication skills that underpin this are introduced into your own everyday work, merely rehearsing the learnt phrases for the examination will not be enough for you to succeed in passing the clinical skills examination for the MRCGP [INT]. The examiners can see where this ethos has been integrated into a candidate's own practice by the fluency, familiarity and personal approach in their interaction with the simulated patients of the examination.

This book suggests opportunities for you to think imaginatively how the scenarios may be applied to your own country, health system and culture. Furthermore, it encourages you to break down the defensive professional boundaries that we have, by suggesting that you identify and work with like minded colleagues, using the scenarios to rehearse what may initially feel are unfamiliar attitudes and language.

Feedback from very many successful MRCGP [INT] candidates has demonstrated how much integrating this approach has improved their own patient care and professional development, which their patients, community and professional colleagues will also recognise.