The Trainers Workshop

MRCGP INTERNATIONALDr Nagwa Eid Sobhy

Chair of Examination Committee

Principles of MRCGP[INT]Endorsing those Examination Bodies who consider the:

• Purpose – in the broader context of Family Medicine

• Content – the curriculum development describing those competencies required for the Family Doctor

• Assessment package planning and ‘blueprinting’ of curriculum

• Standards – how these are set and are calibrated to the MRCGP

• Procedures – quality assurance including examiner training and statistical analysis

Background to the MRCGP[INT]• Support the development of General Practice / Family

Medicine worldwide

• Assist in raising the standards of the discipline

• Explore the different competencies required by Family Doctors in varying cultures, health systems and epidemiology

• Accredit locally developed assessments

• Award in addition to the local qualification

• Award equivalent to Hospital Based Specialities

BackgroundSince the first accredited MRCGP[INT] site in 2001,

examination diets have been run inThe Middle East:• Oman - 7 diets since 2001• Kuwait - 6 diets since 2005• Dubai - 3 diets since 2006South East Asia Pacific:• Brunei - 5 diets since 2002South Asia: Bangladesh, India, Nepal, Pakistan and Sri

Lanka - 2 diets since 2007

BackgroundEurope: The MRCGP examination in UK is the quality assurance

standard for accreditation Kosovo, Malta, Greece are currently working towards

accreditationMiddle East Egypt, Qatar are currently working towards

accreditationElsewhere: Uganda and Nigeria are currently exploring this

accreditation

Assessment Package

• Progression exam• Workplace based assessment• Applied knowledge test• OSCE

Workplace based assessment

• Portfolio • Trainers’ Appraisal Report TAR• Direct Observation of Procedures DOPS

PortfolioSuggested Contents of the portfolio: -

• Research project (thesis)• Logbook• Audit of medical records• Critical appraisal• Continuous Professional Development• Foundation courses• Advanced Life Support • IMCI• Reflective Diary

PortfolioResearch project (thesis): • It will be presented by the end of training as a

prerequisite for the final exam. • Special emphasis on some subjects that might

affect outcomes of health-care: patient safety patient satisfaction Audits referral

Portfolio

Logbook:

• It contains: common casescommon procedures critical incidents.

Portfolio

Audit of medical records:

• each trainee will provide an audit of around ten medical records of patients he served

• this audit will be conducted every FHC rotation

PortfolioDocuments of Continuous Professional

Development:

• journal clubs• Critical appraisal of two related articles per

rotation in FHC.• attended workshops• training courses• conferences

Portfolio• Foundation courses: Communication skills Basics of research Ethics Medecolegal aspects Health care system

• Advanced Life Support • IMCI

Portfolio

Reflective Diary: • action plan recorded every rotation in FHC

according to the feedback from scientific supervisors

Portfolio

Reflective Diary: • action plan recorded every rotation in FHC

according to the feedback from scientific supervisors

Training Appraisal Report; TAR

Frequency of assessment:

• Annual formative report from the trainer and the academic supervisor to evaluate the trainee's achievements and progress

Direct Observation of ProceduresDOPs

Frequency of assessment: • by the end of each rotation the trainee is

expected to provide evidence of competency in performing all listed procedures in this rotation

WBA – the nMRCGP tools

• CBD (case based discussion) • COT (consultation observation tool)• PSQ (patient satisfaction questionnaire)• MSF (multi-source feedback)• mini-CEX (clinical evaluation exercise)• DOPS (direct observation of procedural skills)

Assessment Package

• Progression exam• Workplace based assessment• Applied knowledge test• OSCE

Progression exam• Timing: after the end of the training of the first year

• One paper: MCQs one best single answer • Aim of this exam: early detection of student difficulties

Progression exam

• Introduction to Family medicine and Community Medicine 25• Internal Medicine/ Geriatric 35• Pediatrics/Child Health 25• Psychiatry 15

Assessment Package

• Progression exam• Workplace based assessment• Applied knowledge test• OSCE

Applied knowledge test

Applied knowledge test: 200 MCQs• Paper I: 3 hours 180 MCQs mostly with clinical scenario in• Paper II: 03 minutes 20 MCQs on ECG, X-ray, Lab report, skin rash,

photo of physical sign, growth curve,…..

Blueprint of Applied knowledge test paper: I• Internal medicine & geriatric 30%• Obstetric & Gynecology 15%• Pediatric 14%• Emergency & orthopedics 10%• Community medicine 8%• Psychiatry 7%• Surgery 5%• ENT 4%• Ophthalmology 3%• Dermatology 2%• Male reproductive health 1%• Family life cycle 1%

Common Reference Materials:

• National Guidelines• Oxford Textbook of Primary Medical Care• Rakel Textbook of Family Medicine• Rakel Essentials of Family Medicine• Current Textbook of Family Medicine

Other Reference Materials :

• Taylor Textbook of Family Medicine• NICE Guidelines• SIGN • BNF

Blueprint of Applied knowledge testpaper II

• Photo of physical signs 40%• Lab report 24%• X-ray 16%• ECG 12%• Growth curve & others 8%

Photo of physical signs; 40%

• Skin• Eye• Endocrine• Musceloskeletal• Facial appearance,……

Lab report; 24%

• CBC• Urine / stool• Chemistry• Viral

markers• Immunology• Others

Fasting 110-1262hr <140

Fasting <1262hr 140- <200

Fasting >1262hr >200

ImpairedFasting

Glycemia

ImpairedGlucose

Tolerance

Diabetes Confirmed

X-ray; 16%

• Chest• Heart• Abdomen• bone

ECG; 12%

• Arrhythmia

• Chamber enlargement

• Ischemia & infarction

Others; 8%

• Growth curve,……

Assessment Package

• Progression exam• Workplace based assessment• Applied knowledge test• OSCE

OSCE

Fourteen stations• Twelve stations: CSA: clinical skill assessment. at least 4 cases with physical signs• Two stations: Procedure and/or focused clinical exam

First Mock Exam

• Mock AKT exam (23/3/2009)• Mock CSA exam (15/4/2009)