n MRCGP The Clinical Skills Assessment : an evolving process

1. nMRCGPThe Clinical Skills Assessment :an evolving process Prepared by the CSA Operations Group nMRCGP

2. Health Warning Contemporary as of May 2007

4. Principles of Assessment (from PMETB) Principle 1 The assessment system must be fit for a range of purposes Principle 2 The content of the assessment will be based on curricula for postgraduate training which themselves are referenced to all of the areas of Good Medical Practice Principle 3 The methods used within the programme will be selected in the light of the purpose and content of that component of the assessment framework. Principle 4 The methods used to set standards for classification of trainee’s performance / competence must be transparent and in the public domain

5. Principles of Assessment (from PMETB)continued Principle 5 Assessments must provide relevant feedback Principle 6 Assessors / examiners will be recruited against criteria for performing the tasks they undertake Principle 7 There will be Lay input in the development of assessment Principle 8 Documentation will be standardised and accessible nationally. Principle 9 There will be resources sufficient to support assessment

6. The MRCGP Curriculum Statements (Principle 2) Where to find them • RCGP website What are they? • Series of statements, each covering different clinical and practice management areas, based on European Academy of Teachers in General Practice (EURACT) framework and Good Medical Practice (GMC document) • Written by a variety of experts in their field, coordinated by RCGP

7. The MRCGP Curriculum Statements (Principle 2)continued How they are being used • Curriculum statements subdivided into ‘Intended Learning Outcomes’. Cases linked to specified learning outcomes within specified curriculum statements. • This enables sampling from across the curriculum, as cases can be mapped to the curriculum statements (or nMRCGP blueprint)

8. Components of the nMRCGP • The Applied Knowledge Test Computer-based test of knowledge using multiple-choice questions, completed on-screen in dedicated Pearson Vue driving test centres around the country. • The Workplace Based Assessment Formative and summative; variety of measures; based on a series of reviews; electronic portfolio. Tests trainee in his/her place of work, doing what he/she actually does. • The Clinical Skills Assessment Clinical consulting skills examination, based on cases from general practice, with role players as ‘patients’, and experienced assessors; provides a pre-determined, standardised level of challenge to candidates.

9. Why a Clinical Skills Assessment? • Criticism of current MRCGP that there is no clinical consulting skills component • Provides external validation / triangulation with the other testing methods used • Using simulated patients is a validated and reliable method for testing clinical skills, so long as quality assurance of case production, role player and assessor training is carried out. • Able to offer a standardised, pre-determined level of challenge to candidates and to vary this level of challenge as needed by the assessment requirements

10. Purpose of the CSA : ‘An assessment of a doctor’s ability to integrate and apply appropriate clinical, professional, communication and practical skills in general practice’ Integrative skills assessment - tests a doctor’s abilities to gather information and apply learned understanding of disease processes and person-centred care appropriately in a standardised context, making evidence-based decisions, and communicating effectively with patients and colleagues.

11. Series of Integrated Developments • Curriculum statements form the basis for the nMRCGP blueprint : • Intended learning outcomes - track from curriculum statements to cases via CSA blueprint and case selection blueprint • Competency progression • CSA Blueprint – based on nMRCGP blueprint, those sections that can be tested by this methodology

12. Series of Integrated Developments continued • Case writing proforma that guides case writers through complexities of linking their case, focussing on the ‘nub’ of the case, and writing a marking schedule that reflects this ‘nub’. • Linking the case with searchable keywords so that a defined selection of cases can be found for each time the assessment is run.

13. CSA Blueprint derived from the Curriculum

14. Case Selection Blueprint

15. How does the CSA differ from the Simulated Surgery? • Not just a test of communication skills in a clinical setting • Based on the nMRCGP blueprint, and samples across this blueprint. • Will be taken by many more candidates (3,000 - 4,000 per year) • Assesses integrative clinical skills in primary care settings • Candidates will be expected to undertake focussed physical examinations on some of the role players and be assessed on it

16. What is the CSA likely to look like? • Starts October 2007 • Temporary assessment centre to be used initially in Croydon • Dedicated assessment centre within new College build planned to be ready over the next 3-5 years • Will take place for a number of weeks, several times a year • Will use multiple circuits • Candidate stays in ‘surgery’ and patient and examiner move around circuit

17. What is the CSA likely to look like? continued • Will consist mostly of simulated patient cases. • 13 stations, probably each of 10 minutes • Marks collected by Opscan techniques • Some triangulation with Workplace Based Assessment competencies • Stations picked from intended learning outcomes (ILOs) across the nMRCGP blueprint with clear derivation

19. The Marking Schedule • Each case is marked in 3 domains : • Data gathering, examination and clinical assessment skills • Clinical management skills • Interpersonal skills • All domains have equal weighting

20. The Marking Schedulecontinued • Assessor uses word pictures to help decide grade for each domain, then uses this information to make a judgement on the grade for the case overall (4 decisions) • Feedback to candidates • Serious concerns box

21. Four possible Grades • Clear Pass (CP) • Marginal Pass (MP) • Marginal Fail (MF) • Clear Fail (CF)

22. Three domains for each case :

23. How the CSA is aiming to meet PMETB assessment criteria PMETB ASSESSMENT CRITERIA 1. This methodology is judged to be the best way to test Clinical Skills in general practice currently. 2. Cases are based on the nMRCGP curriculum. 3. Assessment methodology chosen is fit for purpose. This has been validated and reliable, both elsewhere and by our main pilot. 4. Standard setting will be transparent and in the public domain with wide consultation. 5. Feedback will be given to all candidates.

24. How the CSA is aiming to meet PMETB assessment criteria : continued PMETB ASSESSMENT CRITERIA 6. Recruitment of assessors will be on ability – to rank order, mark reliably, knowledge base. 7. Lay input has been consistently sought. 8. Documentation will be accessible nationally through the College website and publication in peer reviewed journals and the various weekly publications. 9. Resources? Continually under review…

25. Further resources • CSA sample cases to be made available soon • Latest information on RCGP website • Introduction to CSA cases document

26. Acknowledgements This presentation written by Kamila Hawthorne Neil Munro On behalf of the CSA Operations group, nMRCGP Updated May 2007

27. Members of the CSA Operations Group • Adrian Freeman GP, FRCGP Examiner, Chair of the Operations Group • Mei Ling Denney GP, MRCGP Examiner and Course Organiser, Deputy Convenor MRCGP Simulated Surgery • Kamila Hawthorne GP and Trainer, MRCGP Examiner, Senior Lecturer in General Practice, Cardiff. • Fiona PattersonProfessor of Work Psychology at City University • Sue Rendel GP, MRCGP Examiner and Convenor MRCGP Simulated Surgery • Amar Rughani GP, MRCGP Examiner, nMRCGP blueprint guardian • David Sales GP, Assessment Fellow, RCGP • Richard Wakeford MA Cpsychol, FRCGP, Assessment Consultant, University of Cambridge. • Faye GeoghegannMRCGP Project Manager