GP Training Pay scales including GP Registrar Pay 2018 – 2019

These are the current pay scales for GP trainees in effect from October 2018 onwards. As the new junior doctor contract is being implemented in England pay scales are now very different in England compared to Wales, Scotland and Northern Ireland. In this article, Dr Mahibur Rahman looks at the current pay scales for both new and old contracts, as well as an estimate of your net pay when in GP practice based posts.

GP Training Pay Scales – New Junior Doctor Contract (England only)

payscales2018

The new contract bases pay on your stage in training: ST1, ST2 or ST3. For hospital posts, the old banding system has been replaced by a complex calculation of pay for hospital jobs which depends on multiple factors including the average number of hours worked per week, number of on calls, frequency of nights, weekend working etc. At the bottom end, some ST1 / ST2 posts with 40 hours per week, no on call commitments, no weekend or night working will have basic pay only of £37,191 (e.g. some public health posts). At the top end, a busy post in emergency medicine with 1 in 3 weekends, an average of 47 hours per week worked and with lots of regular night shifts might give a total package of around £50k.

For posts within a GP practice (when you are designated a GP registrar), there is a fixed additional payment which is £8,448 for the current year pro rata (e.g. if you do 6 months in a GP practice you get half this amount). This allowance is NOT payable when in hospital posts as part of your GP rotation.

If you are training in London, there is an additional London weighting allowance of £2,162 per year.

There is no increase in basic pay between ST1 and ST2.

GP Trainee Pay scales 2018-2019 – Scotland, Northern Ireland and Wales (old contract)

For hospital posts, total pay will depend on the banding (jobs with more on call / antisocial hours carry a higher supplement). Only the most common bands are shown here – some posts may have higher banding payments (Band 1A/2B / 2A). The GP Registrar supplement is currently fixed at 45% – this is for all posts when based in a practice, regardless of the year of  training, or the number of on call or out of hours shifts completed.

If you are entering GP training from another training post, you should start on the paypoint with basic pay that is closest to your current basic pay. E.g. if your current basic is £30,513, you will move onto the StR Min scale, with a basic pay of £30,606 and so on. You will move onto the next point on the scale on the anniversary of your increment date (this should be on your last payslip).

When you are on paypoint StR3 or higher (shown in orange above), you are entitled to an extra 5 days of annual leave – so you will get 30 days instead of 25 in addition to bank holidays. Please note that StR3 is NOT the same as being in your ST3 year. The paypoint is based on past NHS experience, NOT your year of training. For example, a doctor entering GP training straight from Foundation Year 2 will go onto the StrMin payscale during their ST1 year, then StR1 in their ST2 year, and StR2 in their ST3 year. They will have 25 days annual leave in all 3 years of the rotation (you may get 2 extra days for hospital posts). A doctor entering GP training having already completed 2 years of core medical training would start on the StR2 payscale (while in the ST1 year). They would have 25 days leave in this year. In the ST2 year, they would be on the StR3 payscale and get an additional 5 days leave, and so on. There may be slight variations to these payscales between Scotland, Northern Ireland and Wales (a few hundred pounds a year) as annual pay increases are devolved matters.

GP Registrar Salary – Net Monthly Pay – new contract (England only)

Most GP rotations now have 16-18 months in general practice. As there are a lot of costs during the latter part of your GP training, we thought it would be helpful to look at estimated NET pay (i.e. take home pay after Tax, National insurance, and NHS pension). This might help you plan and budget so you can meet the costs of sitting the MRCGP AKT Exam and MRCGP CSA Exam (about £2,000 together) as well as other final year costs such as CCT, indemnity when you qualify as a GP etc.

Payscales2018-net.jpg

GP Registrar Salary – Net Monthly Pay (old contract)

gptraining-pay-oldc

*These figures are estimated monthly take home pay net of income tax, national insurance and NHS pension. They have been rounded down to the nearest pound, and are based on a standard tax code.  As your pay may change during the tax year, the actual amount may differ.  You can get an accurate monthly calculation here (external link).

GP Registrar medical indemnity will be reimbursed less the amount they would have paid for a hospital job.

Pay protection

If you are entering GP training from a training post in a different specialty, or from a non training post in a nationally recognised career grade post (e.g. consultant, specialty doctor, staff grade), then in some cases you may be entitled to pay protection of your basic pay subject to eligibility criteria. Career grade doctors moving from a local grade (e.g. trust grade, trust registrar, clinical fellow) do not get pay protection. Pay protection in the new contract is very complex – you can read an overview here, however I would recommend you contact the BMA for individual advice of your eligibility as in some cases you may be able to get some recognition of past experience on a case by case basis even if standard pay protection does not apply to you.

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Salaried GP Contracts – FAQs

When taking up a salaried GP post, it is important to discuss and negotiate key areas in your contract and agree a job plan. In this article, Dr Mahibur Rahman explores some frequently asked questions about salaried GP contracts.

When should I ask for a contract?

Employers have to give you a written statement covering the main conditions of employment within 2 months of the start of your employment – however, it would be sensible to see this before you agree a start date, and to discuss and negotiate anything that is unclear. If you are a member of the BMA, they have a contract checking service which you can use to get a second opinion on your contract or help with discussions with the employing practice.

What are important areas in the contract to discuss?

A lot of job adverts are unclear with regards to the actual contract or terms of employment. It is important to discuss and clarify the following:

  • Pay – many jobs have no mention of the pay in the advert! You may also wish to discuss when your pay or package will be reviewed (there are no automatic pay rises once you are qualified!).
  • Job plan, including realistic hours or work – if you are expecting to work 9 hours a day, and end up working 12-13 hours most days, the pay that you agreed might not seem so attractive
  • Extended hours, evening or weekend working requirements
  • Leave entitlement – annual leave, CPD / study leave, maternity, sick leave
  • Indemnity cover – will the practice pay or do you have to cover yourself (this can be a significant cost)
  • Recognition of past NHS experience

It can take some time to negotiate and discuss all the important areas, but this is really important as it can have a big impact once you are in post, and you may find it more difficult to make changes after you start.

What is a job plan?

A job plan should outline the details of your role. It could include areas such as:

  • Usual hours of work – including any extended hours
  • Usual number of patients per clinic (morning / afternoon)
  • Time allocated for administration
  • Allocation of home visits
  • Duty doctor or on call doctor sessions – frequency, duties
  • Meetings that you are expected to attend
  • Time allocated for CPD

It is important to agree a job plan before starting, so that both you and the practice are clear regarding the expected hours and workload. If your workload is significantly different or changes after you start, the job plan will be a useful reference point to highlight this. In some cases, this may be helpful to negotiate additional pay or time off in lieu, or to allow you to work more in line with the agreed job plan.

ContractWhat is the BMA model contract?

The model contract sets out standard areas of the contract for a salaried GP that should be offered as a minimum by GMS, and PCO practices. It also applied to PMS practices in England since 2015. It includes the following areas:

  • Pay – the minimum annual salary for a full time post (9 sessions) is £56,525 – many posts advertise pay per session and the bottom end of the BMA scale equates to just £6,280 per session per year. The top end of the scale equates to just under £9,500 per session per year, although some practices may offer more than this.
  • Working hours – full time (9 sessions) is considered 37.5 hours – additional hours should be paid or time of in lieu offered – this is based on a session being 4 hours and 10 minutes
  • Paid CPD time – 4 hours per week paid CPD (1 in 9 sessions)
  • Annual leave – 30 days annual leave + 10 bank holidays / statutory days (effectively 32 days annual leave + 8 bank holidays)
  • Maternity leave – subject to qualification, 8 weeks full pay, 14 weeks half pay, 17 weeks SMP or MA, 13 weeks unpaid leave
  • Sick pay – based on continuous NHS service, up to 6 months full pay + 6 months half pay
  • NHS continuous service – all past continuous service to be recognised (not just employment with the current practice)

What does the term salaried GP cover?

It includes all of the following job titles as well as salaried GPs (this list is not exhaustive):

  • Salaried GP who undertakes special interest work (a GPwSI)
  • GP retainer
  • GP assistant / associate
  • Flexible Career Scheme GP
  • Returner scheme GP
  • Salaried GP employed to work out-of-hours via a PCO

I have a job offer from a PMS / APMS practice. The contract they have offered me has much less paid sick leave / maternity / annual leave / CPD compared to the BMA model contract. What can I do?

The model contract applies to GMS practices, and practices that are directly run by Primary Care Organisations (like Health Boards). PMS practices in England should also offer it for new contracts after June 2015.  PMS practices outside England and APMS practices are not obliged to offer the BMA model contract, although some may offer some or all parts of it as an aid to recruitment. If you are not happy with any part of the offer, it is important to discuss and negotiate with the practice before accepting. Some doctors will be happy to have less paid CPD time in exchange for more annual leave or higher pay. Most areas of a contract are negotiable – hopefully you can come to an agreement that is mutually satisfactory. If you cannot, then there is no obligation to accept an offer that you feel is not adequate – you could look for another post.

There is a lot of variation in contracts offered to salaried GPs between practices, even in the same area. Each practice will have their own way of working and as a newly qualified GP, you may be unfamiliar with negotiating and discussing areas like pay – GP registrars have a standardised contract and the pay scales are nationally agreed. You may find it helpful to discuss any offer with an experienced colleague to get their advice.

Dr Mahibur Rahman is the medical director of Emedica. He teaches on the Emedica Life after CCT: GP Survival Skills course which includes sessions on salaried GP contracts, partnerships and succeeding as a GP locum. It also includes practical advice and demonstrations on how to negotiate contracts. You can see more details at http://courses.emedica.co.uk/acatalog/RCGP_MRCGP_CCT_GP_Careers.html 

GP Training Payscales including GP Registrar Pay 2016 – 2017

These are the current payscales for GP trainees in effect from August 2016 onwards. Current trainees will start to be moved to the new junior doctor contract from October 2016 onwards – we will publish an update if this is implemented, once full details are available.  For hospital posts, total pay will depend on the banding (jobs with more on call / antisocial hours carry a higher supplement). The GP Registrar supplement is currently fixed at 45% – this is for all posts when based in a practice, regardless of the year of  training, or the number of on call or out of hours shifts completed.

GP Trainee Payscales 2016-2017

gptraining-pay-2016

If you are entering GP training from another training post, you should start on the paypoint with basic pay that is closest to your current basic pay. E.g. if your current basic is £29,500, you will move onto the StR Min scale, with a basic pay of £30,302 and so on. You will move onto the next point on the scale on the anniversary of your increment date (this should be on your last payslip). If you are entering training from a non training post, then you may be entitled to pay protection if you are in a nationally recognised career grade post (e.g. consultant, specialty doctor, staff grade). Career grade doctors moving from a local grade (e.g. trust grade, trust registrar, clinical fellow) do not get pay protection.

When you are on paypoint StR3 or higher (shown in cream above), you are entitled to an extra 5 days of annual leave – so you will get 30 days instead of 25 in addition to bank holidays. Please note that StR3 is NOT the same as being in your ST3 year. The paypoint is based on past NHS experience, NOT your year of training. For example, a doctor entering GP training straight from Foundation Year 2 will go onto the StrMin payscale during their ST1 year, then StR1 in their ST2 year, and StR2 in their ST3 year. They will have 25 days annual leave in all 3 years of the rotation. A doctor entering GP training having already completed 2 years of core medical training would start on the StR2 payscale (while in the ST1 year). They would have 25 days leave in this year. In the ST2 year, they would be on the StR3 payscale and get an additional 5 days leave, and so on.

GP Registrar Salary – Net Monthly Pay

Most GP rotations now have 16-18 months in general practice. As there are a lot of costs during the latter part of your GP training, we thought it would be helpful to look at estimated NET pay (i.e. take home pay after Tax and National insurance). This might help you plan and budget so you can meet the costs of sitting the MRCGP AKT Exam and MRCGP CSA Exam (about £2,100 together) as well as other final year costs such as CCT, indemnity etc.

gp-registrar-pay2016*These figures are estimated monthly take home pay net of income tax and national insurance. They have been rounded down to the nearest pound, and are based on a standard tax code.  As your pay may change during the tax year, the actual amount may differ.  You can get an accurate monthly calculation here (external link).  These figures do not include deductions for the NHS pension – although you can put pension into the calculator to get an accurate amount. If you are paying into the NHS scheme, expect a take home pay around £200 a month lower than the figures above.

GP Registrar’s medical indemnity will be reimbursed less the amount they would have paid for a hospital job.

MRCGP AKT Exam Revision – High Yield Topics from the January 2015 AKT Exam

MRCGP AKT Exam – High Yield Topics from the January 2015 AKT Exam

Dr Mahibur Rahman153080449

After each MRCGP AKT examination, the examiners release a report highlighting key information from the last exam. This includes pass marks and rates, and also key topics – both those that were answered well, and those that GP trainees performed poorly on. These topics are frequently examined again in the next few sittings of the AKT exam, so it is worth ensuring that you have a good understanding of them.

As some of you may be preparing for the April or October MRCGP AKT Exam at the moment, we thought it would be helpful to look at the high yield topics from the latest examiners’ report.

Key facts from the January 2015 MRCGP AKT exam:

The top score was 97.5%
The mean score was 76.9% (this is higher than usual)
The lowest score was 45%
The pass mark was 71.5% (this is the highest it has ever been so far)
The pass rate was 75.8% (higher than average sittings)

Scores by domain:

Clinical medicine – 77.1%
Evidence interpretation – 77.2%
Organisational – 74.8%

High Yield Topics

The examiners’ report from this diet of the MRCGP AKT exam highlighted the following key topics:

  • Sickness certification
  • National screening programmes
  • Immunisation
  • Emergencies – including anaphylaxis, CPR
  • Antibiotic prescribing
  • Serious but rare conditions – adults and children
  • Childhood asthma management
  • Contraception – including “quick start”
  • Headaches

The MRCGP AKT is a comprehensive examination, so it is important that you cover the entire curriculum. Remember that 80% of the marks are related to applying knowledge relating to clinical medicine in general practice, 10% to evidence interpretation and 10% to the organisational domain.

Emedica Alumni can get a £20 discount off the Emedica MRCGP AKT course by entering this code when booking: alumnimrcgp

Our AKT course offers comprehensive coverage of all 3 domains, and is updated after every exam to take account of high yield topics from the examiners’ feedback reports.

Further reading:
Complete Examiners’ report – January 2015 MRCGP AKT Exam

Improving feedback from the MRCGP CSA examination

Improving feedback from the MRCGP CSA examination

Dr Mahibur Rahman

We are often contacted by GP registrars or GP trainers requesting support with understanding the feedback from the MRCGP CSA. Many doctors have commented that they find the feedback difficult to interpret. This has been recognised as an important issue and recently a motion was passed at the LMCs conference calling for immediate improvement in the feedback from the CSA. In this article Dr Mahibur Rahman looks at the current feedback, the areas that could be improved and suggestions on ways to make the feedback clearer and more helpful for both trainers and registrars.

Understanding the current CSA feedback

Currently there are 2 main sections to the feedback from the CSA. The top part gives the candidate’s total score from all 13 cases (out of 117), with the pass mark for the date they sat the exam. This total score is based on the summative part of the assessment, which is based on 3 domains for every case: data gathering, clinical management, and interpersonal skills.

For each domain, a candidate is graded with a score attached to each grade as follows: Clear pass: 3 marks, Pass: 2 marks, Fail: 1 mark, Clear fail: 0 marks. This gives a total score for each case of between 0 and 9.

To gain a pass, a candidate must get an overall score equal to or above the pass mark for a given day. This is adjusted each day using the borderline group method to ensure the standard of the exam remains the same each day. The actual pass mark is variable with a usual range between 72 and 77 out of 117.

The second part of the feedback is formative – it relates to the 16 feedback statements provided by the RCGP in a grid. This grid can provide information on consulting areas that a candidate could improve on. It is important to understand that this part does NOT determine the score or whether a candidate has passed or failed – it is formative, and aimed at helping doctors identify areas of their consulting that they could improve. The current feedback looks like this:

CSA feedback current

What are the problems with the current feedback?

There is no breakdown of the marks awarded from each case (out of 9), and no way for a candidate or trainer to see clearly if marks were dropped in data gathering, clinical management or interpersonal skills for each case, or as a general trend over the course of the whole exam.

In some cases, the formative feedback can help identify areas to work on, but in some cases it can lead to confusion. A common source of confusion relates to the fact that candidates with the same number of crosses can have very different scores. Finally, where a candidate has no crosses relating to a specific case, many candidates think that it means they must have scored very well, or at least gained 6 or more marks out of 9. However it is impossible to tell how well or poorly they have performed in that case from the lack of crosses– they could have scored anywhere from 0 to 9. This is because:

  • The formative feedback does NOT determine the score for a case – this is determined by the performance in the 3 domains being assessed. Scores for these are not provided in the current feedback as standard – candidates that want to access these scores can request their mark sheets under the Data Protection Act.
  • Only feedback statements that were flagged in 2 different cases show up in the feedback provided to candidates – there are hidden crosses where a statement was only flagged in a single case. A candidate with no crosses could actually have had several crosses relating to feedback statements that did not occur again in other cases. This could have led them to score very poorly in that case, but they would not know it from looking at the feedback.

This candidate failed the CSA by a few marks – look at the formative feedback for their first 3 cases:

CSA formative feedback - current

This candidate scored 7/9 for the first case (joint problems), and 2/9 for the second case (acute illness), but there would be no way to know that they had performed really poorly in the second case from the current feedback. There were actually 3 feedback statements that were flagged in this case, but they don’t show up because those statements did not apply to any other case (and currently these statements are hidden).

How could the feedback be improved?

The GPC motion called for “the feedback from the MRCGP exams to be improved immediately”. Here are 3 simple ways that the feedback could be made clearer and more effective in helping identify areas to work on to improve performance. They can all be introduced using data that is already collected in the exam, and so could be implemented quickly with little additional cost.

1. Provide a breakdown of total marks for each domain as well as the total score. In the AKT, candidates get a breakdown of their scores in the 3 domains (clinical medicine, organisational, and evidence interpretation). This will give a clearer indication of any weaker areas overall:

New CSA feedback - summative

This candidate and their trainer can immediately see that they could make improvements in all parts of the consultation, but that the clinical management domain was their weakest overall. This may allow more targeted work on this part of the consultation. Without this information, this candidate (and their trainer) may focus more on the interpersonal domain, without realising that although this could be improved further, this is actually their strongest domain overall.

2. Provide the domain scores for every case as well as the formative feedback. Taking both the summative and formative feedback together provides more meaningful information and will allow easier identification of both consulting skills and curriculum areas that need improving. This could be provided by adding a separate table for the domain scores:

CSA domain feedback for individual cases

Looking at this, it is clear that this candidate had 2 cases where they performed very poorly – the young adult female with an acute illness, and the middle aged female with a women’s health issue. These may be areas that they struggle with, and indetifying them will allow focused improvement in knowledge.

3. Provide details in the formative feedback section of ALL statements that were flagged, even when this only applied to a single case. This will allow candidates to identify all areas that examiners felt they could work on – even candidates that have done well can benefit from knowing areas that they could improve. Combined with the summative feedback above, this would also make it easier to separate a candidate that is below the pass standard in multiple areas of multiple cases from one that had a couple of really poor cases due to poor knowledge of a specific curriculum area, or because they missed something key in that case. Here is the formative feedback from those first 3 cases that we looked at earlier; the second image shows all crosses (those that were previously hidden are shown in red for clarity):

Current feedback:

CSA formative feedback - current

Proposed feedback:

Proposed feedback showing all crosses

You can see that taking this with the domain scores, it is immediately clear why this candidate got such a low score in the acute illness case, and that had they performed better in this case, they may have passed. This would also help candidates understand their performance better. From the current feedback they may think that this was one of their better cases when actually it is their worst. Providing this extra information does not give any information that will jeopardize case security, but it does provide more meaningful information for someone trying to improve.

How it would look together

All the feedback would fit onto 1 A4 page, allowing quick cross referencing between the different sections. This is how the new feedback could look in the e-portfolio.

New CSA feedback - summative

CSA domain feedback for individual cases

New CSA feedback

Summary

It is clear that further research needs to be carried out to investigate the possible reasons behind the differential pass rates in different groups – however this will take time. By improving feedback immediately, we can ensure that candidates and trainers have clearer, more effective feedback. All these changes can me made using data that is already being collected, so this could be implemented quickly and with little additional cost. Hopefully this will enable more focused work on the key consultation skills that an individual doctor may need to work on to help them improve and pass the exam.

Are you a GP trainer or a GP registrar? What do you think about these ideas for improving the feedback from the CSA? Please share your thoughts!

MRCGP CSA Exam Feedback and Summary – February 2012 exams

MRCGP CSA Exam Feedback and Summary – February 2012 exams

Dr Mahibur Rahman

After each MRCGP CSA examination, the examiners release a report highlighting key information from the last exam. This includes pass marks and rates for the sitting, along with the number of candidates sitting the exam. Since the February 2012 exam they also started releasing a feedback report highlighting key areas that candidates found challenging.

These topics are likely to continue to feature in future CSA sittings, as there is a common case bank, so it is worth ensuring that you have a good understanding of how to tackle them.

If you are thinking of sitting the MRCGP CSA in November 2012 or January / February 2013, then you have probably started preparing. As the January / February sitting is the most popular each year, we thought it would be helpful to look at the feedback and challenging areas from this sitting in 2012. The sumary report for the May 2012 CSA exam is not yet available.

Key facts from the February 2012 MRCGP CSA exam:

Number of candidates: 2074

Proportion sitting the CSA for the first time: 92.5%

Overall pass rate: 71.8% (1490 candidates passed, 584 candidates failed)

The top score was 111 out of 117
The mean score was 81 out of 117
The lowest score was 37 out of 117
97 candidates (4.7%) scored 100 or more out of 117
67 candidates (3.2%) scored 20 or more marks below the pass mark.

Challenging areas

The examiners’ report from the February 2012 diet of the MRCGP CSA exam was released in April, and highlighted the following areas that caused candidates difficulty:

Genetics in primary care

Cases involving genetics regularly cause CSA candidates problems in the exam. Examples of cases you should be prepared to handle include:

Prenatal counselling for risk of single gene disorders – e.g. sickle cell disease, Huntington’s, neurofibromatosis, cystic fibrosis etc.

An asymptomatic patient requesting a colonoscopy with a family history of colon cancer.

While you do not need to have an in depth knowledge of specific genetic disorders, you should be able to take a good history and draw a family tree. You should also be able to explain the difference in risk for autosomal dominant and autosomal recessive disorders, and know when it is appropriate to refer to a genetics counselling service.

Examinations

In some cases in the CSA you will actually perform a physical examination. In some cases, candidates lost marks for being unable to be focused in their choice of examination, or not being able to perform the examination proficiently. Examples of a lack of focus would include requesting a full physical examination in someone with hearing loss – it would be more appropriate to examine the ears, and to perform a Rinne and Weber test. Examples of an inadequate examination highlighted by the examiners included listening to a patient’s chest with through their shirt! Most examinations in the CSA are fairly straightforward – you should try to practice all the common examinations with a study group until you are fluent. Ask your trainer to observe you and to provide feedback.

The MRCGP CSA is a challenging, comprehensive examination, so it is important that you start preparing for it early. Try to get as many observed consultations as possible with your trainer, and form a study group early on.

Further reading:
Complete February 2012 CSA Summary report

The Emedica MRCGP CSA Course includes teaching on the new CSA mark scheme including the new 2012 CSA feedback statements. Each course only takes 6 GP registrars, with a strong emphasis on practice with individual feedback. Practice sessions are donw in groups of 3, allowing each candidate to have 4 mock CSA practice cases. There is detailed, constructive 1 to 1 feedback after each case using the new marking criteria. Our mock CSA cases are done in a realistic setting with professional simulated patients and timed in the same way as the real exam. Alumni members can get a £20 discount by using the code alumnimrcgp

 

MRCGP AKT Mock Exam launched – 25% discount for alumni

We are pleased to announce that our complete AKT Mock Exam has been tested and is now available.  The online service has a complete AKT mock exam consisting of 200 AKT questions compiled in a realistic mock AKT exam.  Questions are laid out with a similar screen layout to the real exam, to help increase your speed in dealing with the layout in the real AKT exam.

The mock exam has been developed over the past few years, and is a realistic reflection of the real AKT exam – we have modified some of the questions based on feedback from doctors that have sat and passed the real exam. We have also included high yield AKT questions based on examiners’ feedback reports from recent past AKT exams.

The mock exam is timed just like the real exam – 200 AKT questions in exactly 3 hours.  The AKT questions have been written to reflect the same level of challenge as the real exam, and includes the same proportion of questions from each domain as the real exam:

80% clinical medicine – including wide coverage of the RCGP curriculum areas.

10% organisational – practice management, medicolegal issues, statutory duteis of a doctor, DVLA guidelines, sickness certification etc.

10% evidence interpretation – statistics, types of study, interpreting graphs and charts.

The AKT Mock Exam usually costs £20, but we are pleased to offer Alumni a 25% discount – you can save £5 and pay just £15 by using the code aktmock in the coupon code box when registering. Get full details of the complete AKT Mock Exam and see how ready you are for the real AKT exam today!

Doctors that attend the Emedica AKT Preparation Course get free access to this mock exam after attending the course.

MRCGP CSA Preparation – Tips to help you pass the MRCGP CSA exam

CSA Preparation – Tips to help you pass the MRCGP CSA exam
Dr. Safiya Virji

The MRCGP CSA examination is a challenging exam. Dr Safiya Virji sat and passed the exam on her first attempt with one of the top scores in the country. In this article she shares some tips on preparing for the CSA exam.

An important step in successfully passing the CSA is to make a decision early on which sitting to go for, and actively work towards being thoroughly prepared by this time. I made the decision six months beforehand. I had just started my ST2 placement in GP and took this opportunity to practice various consultation styles until I found one that suited me and came more naturally to me.

I ensured that I was videoed frequently from very early on and did not let the embarrassment of watching myself on the screen stop me from getting vital feedback from my trainer. I was always conscious to encourage my colleagues to give constructive criticism so that I had identified specific points to improve over the coming weeks. I also gradually reduced my consultation times; starting at 20 minutes and gradually working down to 10 minutes about two months before the exam.

I found joint surgeries with my trainer and other partners at the surgery extremely beneficial. Not only can you see alternative ways of phrasing things, but it also gives you a chance to see how you are inclined to perform when you don’t know who or what is going to come through the door and you are being watched. Conducting these on a weekly basis meant by the time the exam came, I was already comfortable with the scenario of being watched conducting consultations I was not familiar with, so was less nervous then you would expect in such a weighty exam. This enabled me to perform to the best of my abilities when it really counted.

It is important to use all opportunities as exam practice. Every patient you see is an opportunity to practice explaining a diagnosis in layman’s terms or to ask about what they think may be causing their presenting complaint. Anything that goes wrong in your consultations is worth jotting down and discussing with your trainer afterwards. It could be the phrasing, or it could be bad choice of questions. I found the more that went wrong, the better I was getting, as I was prepared for all eventualities.

I was also part of the on-call rota and working on emergency patients with a seven minute consultation time from about four months before the exam. This in combination with the GP out of hours (OOH) gave an excellent opportunity to practice for the exam. I took the opportunity in OOH to ensure every patient I saw was observed by the trainer, timed and feedback was given.

I read a selection of case books including:
nMRCGP – Practice Cases, Clinical Skills Assesment – Raj Thakkar
CSA Scenarios – Thomas M Das
Consultantion Skills for the new MRCGP – P Naidoo & C. Monkley
Get Through New MRCGP: Clinical Skills Assessment – Bruno Rushforth (this was the best book for role play in my opinion)

I tried to use these for role plays with colleagues at least for a one hour session a week, increasing this to 2-3 hours a week in the last month before the exam. However, I also read these books in my own time to learn how simple presenting complaints can often have an unbelievable amount of depth, and how missing out one vital question can lead to missing the underlying point of that consultation.

Regarding examinations, I watched videos on how to do the examinations thoroughly yet quickly, and used my own equipment to perform these multiple times on family and friends in the week before the exam so examinations were fresh to hand if necessary.

In preparation for the exam, I set myself a target to complete all consultations within 8 minutes. Strict time management a month before the exam meant I was used to working at a fast enough pace that would ensure I would not over run in the exam, even with the unexpected cases which take a few seconds longer.
I ensured I was always trying to examine the patient by 5mins, and always kept a note of the start and finish time of each consultation to ensure I was always working to time.
In the exam, on several occasions I was still conversing with the patient when the bell rang. However, it seemed I covered enough material at the end of the 10 mins to pass well on each station.

Having sat the exam before all my colleagues, I was not exposed to many horror stories about the exam. This meant I was optimistic when exam time came. A combination of this, alongside minimal nerves and trying my best to apply a structure that worked for me when things were going to plan, and adapting my consulting style when I needed to be flexible, plus a happy face, lead to my passing with a score of 106/117. And I forgot to mention, when I sat the exam I was 38weeks pregnant!

One month before the exam I went on several courses, one of which was the Emedica MRCGP CSA course. I found the course useful as it tackled preparation slightly differently to other courses. The group was very small (courses take just 6 candidates per day). This meant there was time to focus on each trainee independently and specific feedback was given on their performance. By the time you go on any course, you have usually had experience of the simple well known cases, but the scenarios at the Emedica course were slightly more complex then average which meant you were prepared for the more challenging cases in the real exam.

Some of the cases in the CSA do throw you so having some practice at performing under pressure can mean the difference between a pass and fail. The feedback on the course was very useful as it was not based just around what was done well, but more on what needed to be improved on in order for you to pass, and pass well. For me, this approach was more beneficial as I always maintained the attitude that by taking constructive criticism on board, I was far more likely to pass as all my flaws would be ironed out by the time the exam came round. After the course, further reading material and links were provided, including videos of common examinations. This was very helpful as though it is not a huge part of the exam, when it does come up, it is essential they are performed fluently and effectively so that the correct diagnosis is made.

In summary, the my key tips to help you pass the MRCGP CSA exam are:

• Give yourself enough time to prepare – I started 6 months before the exam
• Use all opportunities as CSA practice opportunities – surgery, OOH, on call
• Be observed as much as possible – joint surgeries and video surgeries are both helpful
• Actively seek constructive feedback – and use it to develop your technique
• Create an effective structure that works for you and apply it as much as possible
• Get used to working under time pressure – being comfortable with 10 minute consultations really helps
• Don’t let stress on the day change your attitude toward exam consultations – keep calm and carry on

One last point, once you have finished with one patient, don’t analyse or get upset in the exam, move your focus onto the next one and give it your best!

Dr Virji is a GP Registrar (ST3) in Oxford Deanery. She passed the MRCGP CSA exam on her first attempt, and scored 106 marks out of a maximum of 117.

The Emedica MRCGP CSA Course includes teaching on the new CSA mark scheme including the 2012 CSA feedback statements. Each course only takes 6 GP registrars, with a strong emphasis on practice with individual feedback. Practice sessions are donw in groups of 3, allowing each candidate to have 4 mock CSA practice cases. There is detailed, constructive 1 to 1 feedback after each case using the new marking criteria. Our mock CSA cases are done in a realistic setting with professional simulated patients and timed in the same way as the real exam.

MRCGP AKT Exam – High Yield Topics from the January 2012 Exam

MRCGP AKT Exam – High Yield Topics from the January 2012 Exam

Dr Mahibur Rahman

After each MRCGP AKT examination, the examiners release a report highlighting key information from the last exam. This includes pass marks and rates, and also key topics – both those that were answered well, and those that GP trainees performed poorly on. These topics are frequently examined again in the next few sittings of the AKT exam, so it is worth ensuring that you have a good understanding of them.

With the April 2012 MRCGP AKT Exam coming up, we thought it would be helpful to look at the high yield topics from the latest examiner’s report.

Key facts from the January 2012 MRCGP AKT exam:

The top score was 94.5%
The mean score was 73.1%
The lowest score was 42%
The pass mark was 68%
The pass rate was 74.9%

Scores by domain:

Clinical medicine – 74.6%
Evidence interpretation – 69.2%
Organisational – 65.4%

High Yield Topics

The examiners report from the January 2012 diet of the MRCGP AKT exam highlighted the following key topics:

• Hypertension management
• Drug dosage calculations
• Drug management of neurological conditions (e.g. Alzheimer’s)
• Dementia assessment
• Erectile dysfunction
• Childhood development
• Neonatal problems
• Contraception – including LARCs and side effects
• Certification – fit notes, insurance reports
• DVLA guidelines
• Vaccinations

The MRCGP AKT is a comprehensive examinations, so it is important that you cover the entire curriculum. Remember that 80% of the marks are related to applying knowledge relating to clinical medicine in general practice, 10% to evidence interpretation and 10% to the organisational domain.

Emedica Alumni can get a £20 discount off the Emedica MRCGP AKT course by entering this code when booking: alumnimrcgp

Further reading:
Complete January 2012 MRCGP AKT examiners report

Alumni discounts 2012 – MRCGP courses / CCT courses

We are happy to offer the following discounts for Alumni.  These discounts are valid for bookings made until 31 December 2012.

MRCGP for Trainees: Understanding the AKT and CSA coursesSave £50 off the full price on any of our MRCGP for Trainees courses (available in Birmingham and London) – enter the code elumnus – These courses are aimed at doctors in ST1 and ST2 that want a better understanding of the MRCGP exams.

MRCGP AKT Preparation coursesSave £20 off the full price on any of our MRCGP AKT preparation courses (available in Birmingham and London) – enter the code alumnimrcgp – These courses are aimed at doctors already preparing for the MRCGP AKT exams – the best time to attend is about a month BEFORE your AKT exam date.

MRCGP CSA Preparation coursesSave £20 off the full price on any of our MRCGP CSA preparation courses (available in Birmingham and London) – enter the code alumnimrcgp – These courses are aimed at doctors starting their preparation for the MRCGP CSA exams – the best time to attend is about 2-3 months BEFORE your CSA exam date.

Life after CCT course coursesSave £95 off the full price on any of our Life after CCT courses courses (available in Birmingham and London) – enter the code alumnicct – These courses are aimed at doctors finishing their GP training this year or in the first few years post qualification.