nMRCGP

Dr Mark Metcalfe

nMRCGP

Money AKT CSA

Money

Become AiT £492 AKT £360 CSA £1260 Fee to PMETB £780 TOTAL £2892

Course £660 TOTAL £3552

Money

If you have to retake your exams…. £5282

These are figures for this year…. They might increase

Registrar pay

Basic salary £30660 plus 50% £15330 London weighting £2162

TOTAL £48152

Exams

AKT Computer marked ‘multiple choice’ paper

CSA Practical assessment of consulting skills

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

Sources

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

This is your friend

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

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

Essentials for AKT

Know latest guidelines

Know the BNF

Know basic stats

Your core medical knowledge is probably already sufficient.

AKT

1164 candidates Mean score 76.5% Pass mark 69.85% Pass rate 83.7%

Pass rate ST2 76% Pass rate ST3 88%

AKT – Areas of weakness

Asthma COPD Certification Travel health (vaccinations and commonly

used drugs) Management of dermatological problems National screening programs

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

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.

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.

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

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.

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.

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 don’t have to remember them.

Abnormal findings will be common GP tests. Eg. Hb, HbA1c, urinalysis etc. It will not be anything obscure.

CSA – Management plans

If you want to prescribe a drug you don’t 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.

CSA – Management plans

DON’T 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

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’

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.

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.

CSA

But those domains have no meaning…

What are they actually looking for?

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

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

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.

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.

I Failed?

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

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

Interpersonal skills

Does not identify patient’s 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 patient’s feelings in all aspects of the consultation including physical examination

Global

Disorganised / unstructured consultation Does not recognise the challenge (e.g. the

patient’s problem, ethical dilemma etc.) Shows poor time management Shows inappropriate doctor - centeredness

Essentials for CSA

Be in general practice for a few months

Consult at ten minutes