Introduction to the Course and the Exam

TheYorkshire MRCGP Prep Course handbook - candidates
2006 edition

Yorkshire Faculty of the RCGP

INTRODUCTION TO THE COURSE AND THE EXAM

The Royal College of GPs - membership

Why do the MRCGP exam? What Have Other People Who Have Taken it Thought?

Icons Used In this Guide

Do You Want to Pass or Fail?

Course Tutors

THE MCQ

How to fail the MCQ

Preparing for the MCQ

Hot Tips for the MCQ

Format

FILLING IN THE BLANKS MADE SIMPLE

MCQ PRACTICE (answers at the end)

MODIFIED ESSAY QUESTIONS

Modified Essay Questions (MEQs)

What are MEQs all about then?

How to fail the Written Paper

Preparing for the Written Paper

Hot Tips for the Written Paper

Specific questions and what they mean

Answer Construction

Common MEQ Scenarios

MEQs – Made Simple!

Buzz Words and Triads

Mental Grids/Check Lists/Constructs

Practise MEQ Paper

CRITICAL READING QUESTIONS

Critical Reading Questions (CRQs)

How to fail the CRQs

Preparing for the CRQs

Hot Tips for the CRQs

CLINICAL EPIDEMIOLOGY FOR THE MRCGP EXAMINATION

STATISTICAL TERMS- made simple

Critically Evaluating Quantitative Papers – Made Simple!

Evaluating Quantitative Papers – Method 2

EVALUATING QUALITATIVE PAPERS

Screening – Made Simple!

Critically Appraising Protocols – Made Simple!

A Critical Reading Question Illustrated

THE ORALS

The Orals

Can You Tell Me a Bit More About the Contexts?

Examples of Questions, areas of competence being tested and in what context

What Happens on the Day?

Tell me a bit more about the questions

How to fail the Orals

Preparing for the Orals

Hot Tips for the Orals

Let’s put you at ease…

WORKED EXAMPLE: Orals

Practise Oral Questions

Popular Domains tested in the Orals

MRCGP Orals: Grade Descriptors (revised 05.00)

Introduction to the Course and Exam

The Royal College of GPs - membership

What’s it all about then?

The college was Europe's first academic body for GPs

“It is not that we are better doctors, but that we want to become better doctors” (Fraser Rose, 1953)

By the way, you might be asked about the RCGP in the orals examination.

When was the RoyalCollege of GPs set up?

The examination was introduced in 1965 as the means to entry for new members. Fellows were first appointed in 1967.

What are its aims?

“to encourage, foster and maintain the highest possible standards in general medical practice and, for that purpose, to take or join with others in taking any steps consistent with the charitable nature of that object which may assist towards the same”

Under its royal charter, the college is entitled to:

Establish and maintain an academic and educational headquarters for GPs
Maintaining an authoritative voice to speak effectively for GPs; lobbying government and other organisations on behalf of GPs and their patients.
Taking the initiative for quality patient care in a changing health service
Maintain regional faculties to further the college’s objectives
Encourage able entrants to medicine and to general practice
Undertake training courses designed to enhance the medical knowledge and skill of GPs
Grant postgraduate diplomas or other certificates
Encourage GPs to publish research into medical and scientific subjects
Co-operate with other bodies

Can a GP be a member without taking the exam?

GPs cannot be full members of the college without first passing the MRCGP exam. There is a separate category of associate membership which those without the MRCGP may wish to consider. With this you can receive the BGJP, RCGP publications and discounts on courses. More on .

How can “grass root” GPs voice their concerns?

All members can give their input via their local RCGP faculty and the area representative on the RCGP council.

Tell me more about the RCGP Council.

The council represents all members and meets roughly 6 times a year to discuss current issues. The RCGP is run by the council. The council is made up of officers elected by RCGP members or by the members of the council itself. There are also LOCAL faculty meetings (again around 6 times a year) who meet to discuss more local issues and policies.

What do members actually get for their money?

All members become automatically enrolled in a local faculty which means they have available to them: an educational programme, audit/research opportunities and help, social support and advice.
You get the BGJP, RCGP papers and RCGP books at discount price.
You can apply for RCGP prizes, travel scholarships and research grants.
Access to the RCGP library and information resources centre (including an on-line search service)
Support and friendship from like minded colleagues (local faculty support networks)

What do you get foryour membership?

Free monthly copy of the British Journal of GeneralPractice
Reduced rates on RCGP publications
Use of a comprehensive library and informationservice
Vocational Training Statements free to GP registrars
Computer assessment program on CD for GPregistrars, available at reduced rates
Discounted courses, conferences and study days
Residential and conference accommodation at theCollege's headquarters in London
Local support networks through the RCGP's faculties
The opportunity to participate in decision making
The opportunity to make real changes in primaryhealth care

The object of the RoyalCollege of General Practitioners is

"...to encourage, foster and maintain the highest possible
standards in general medical practice..."

The RoyalCollege of General Practitioners:

develops policy and clinical guidelines for general practice

provides a support network for GPs

works to develop teamwork in primary care

maintains quality and standards in medical practice

facilitates research

publishes on clinical areas, management and policy

campaigns to raise the profile of primary care

works for the benefit of both doctors and patients

Royal Collegeof General Practitioners14 Prince's Gate, LondonSW7 1 PU Tel: 020 7581 3232 Fax: 020 7225 3047

Your local Facility is the: RCGP Yorkshire FacultyAcademic Unit of Primary Care 20 Hyde Terrace, Leeds, LS2 9LN

Tel: 0113 343 4182 Fax: 0113 343 4181

Email: yorkshirercgp.org.uk Website:

Why do the MRCGP exam? What Have Other People Who Have Taken it Thought?

“The impression is of a very honest and fair exam which is genuinely trying to tease the best out of candidates”

Phil Hammond, Lecturer and GP in Birmingham

Almost everyone thinks they have cancer. This is just one of the strange truths I have uncovered since asking about patient's ‘health beliefs’. No matter what symptom a person presents with, if you asked them something along the lines of “Do you have any particular concerns about what you are experiencing?”, you will receive the sometimes shy sometimes bluff reply “Well, could it be cancer?”. This is when you have the chance to really get stuck into the consultation.

I sat the MRCGP exam last summer as part of my registrar year. At the time I decided to sit it, it was just another hurdle, but as the year progressed my approach changed.

The work for the exam became part of my day-to-day practice and, for the first time ever, revising for an exam seemed directly relevant to my daily work. The preparation for the four modules of the exam was incorporated into practice in different ways.

By ploughing through MCQs I went back to the basic medicine that had become a slightly hazy memory from my time at medical school. I read journals and was up to date with current topics, formed opinions, and was able to discuss them coherently with fellow professionals (which is mostly what the oral exam requires).

When reading new papers in journals I finally learned to analyse them in enough to draw my own conclusions, a technique that I had never really mastered in the past (I've always been frightened of statistics!).

But more than anything, working for the exam gave me confidence in my general medical knowledge, in managing clinical problems, and in my face-to-face consultations.

And that raises the issue of that video. How I sweated and cried over the task - especially when my unfortunate trainer accidentally wiped some of my tapes!

Nevertheless, the effort was worth while. Using the framework of the video module's past criteria for my consultations transformed the way I dealt with patients, including discovering “health belief”, which was a novel concept to me after my hospital work.

And knowing that the examiners had seen my new consulting style and passed me was a great boost.

Did the sitting the MRCGP changed my life? No, but it certainly improved the way I practice.

Dominique Thomson, The Practitioner September 2001 volume 245

It was so interesting and rewarding to share the decision-making with my patients, and our relationships seem to blossom. I no longer try to hide from them what I didn't know, or when I wasn't sure, and was surprised and delighted when they seem to respect me for my honesty and appreciate the attempts to include them in managing their own health.

More importantly, the process of preparation encourages candidates to develop an educational discipline that should last a lifetime. Doctors who have gained the MRCGP have proven that they are capable of being good GPs - but they have also acquired the educational skills to continue to develop professionally.

Patti Gardner, The Practitioner, Sep 2001 vol 245

Icons Used In this Guide

How to prepare

How to fail

Hot tips

Tools that might help you with specific types of questions

Test papers for practise

Do You Want to Pass or Fail?

How To Pass

☺Get into the MRCGP “mind set” – read the article: “Passing the MRCGP: Preparing Your Mind”, Daryl Goodwin, The Practitioner, Feb 2000, vol 244 p148-151

☺Get the MRCGP regulations early on and READ them

☺Read the GP press regularly. You will probably need to read the last 6 months of stuff in the BMJ and BJGP. Many questions in the written paper are based on topics covered by the BJGP editorials and this is what you should therefore concentrate on. Don’t forget the GP magazines; they detail news items and hot topics currently in vogue. This can be helpful when question spotting and preparing for the orals.

☺Palmer’s “Notes for the MRCGP” is a great book although out of date in various places. It is particularly good on non-clinical areas. Read the book several times to familiarise yourself with some key concepts and principles.

☺Make sure you are familiar with at least one model of the consultation. Peter Tate’s “The Doctor’s Communication Handbook” is easy to read and pretty concise. Many people like the narrative style of Neighbour’s “The Inner Consultation”. Neighbour provides a simple model of five checkpoints and registrars like this. One of the best books around is “Skills for Communicating with Patients” which is often referred to as the Calgary-Cambridge Model developed by authors Silverman, Kurtz and Draper. Okay, so you may feel daunted at the prospect of the 72 microskills listed but remember, as the book emphasises, the Calgary Cambridge model aims to provide you with a toolkit of 72 skills, not all of which will be required in any one consultation. You use which ever you feel are appropriate. They cover all the skills listed in the MRCGP video marking schedule and it is the ONLY book that provides the evidence behind each skill.

☺GET INTO A SMALL GROUP MRCGP STUDY GROUP at least 6 months before the exam, ideally 1 year. Work through some past papers with friends/colleagues

☺Use frameworks and lists to help prepare for the written (MEQ) and oral exam

☺Early on, start to complete the PEP CDs from the RCGP

☺Video one surgery a week, beginning five months before the submission date

☺Look through your consultations with another person

☺Attend a course. Local MRCGP preparatory courses are particularly helpful for acquiring good exam technique (the process) whilst hot topic courses are helpful for knowledge acquisition (the content).

How to Fail R Neighbour, “How to Fail the MRCGP”, The Practitioner, May 2002 vol 246

×Don't bother reading the exam regulations

If the worst comes to the worst, you can always sweet talk the powers that be into agreeing they don't apply to you.

×Remember the examiners are the enemy

They rejoice in your failure. Every question is an ambush, every instruction or piece of advice should be ignored.

×The college is a club for Smart Alecs

If you're a smart Alec, you’ll pass. If you're not, your best bet is to pretend you are.

×General practice thrives on catchphrases

Say “ideas, concerns and expectations”, or “the implications for the doctor, the patient, the practice and society”, or “there are pros and cons” at every opportunity and watch the examiners swoon with delight.

×Leave your revision until a week before the written is

Why let the prospect of doing an exam force you to read, think or talk about your chosen career and moment before you absolutely have to you? On the other hand, you can never go on too many exam preparation courses, the more expensive the better. After all, reading the Kama Sutra is better than any amount of experience.

×Do not read books

The Guardian is a great favourite with the examiners, but do not read anything so pretentious as a medical journal or a book.

Course Tutors

Mandeep Aluwahlia / GP York
Undergraduate tutor - 2nd year medical students from Hull and YorkMedicalSchool
Hospital Practitioner in dermatology.
Pete Anderson / GP York
GP trainer
Section 12 approved GP
SA video assessor
registrar educational supervisor
Trainer mentor
Kirsty Baldwin / GP (Leeds)
Course Organiser (Leeds)
GP Trainer
Undergraduate tutor
James Crick / GP Scarborough
Interest in pre-hospital emergency care and am on the BASICs PHEC course
Jude Danby / GP (Bradford)
GP Trainer (Bradford)
Owen Dempsey / Salaried GP Bradford
Undergraduate teacher (risk management/communication)
Honorary Lecturer (Health Services Research in primary Care)
Interests in older people with mental health problems, B12 deficiency
RCGP faculty board member
Adrian Dunbar FRCGP / My main claim to fame is attending the MRCGP course annually since 1983 - first 2 as a registrar and as a tutor ever since - guess I must enjoy it.
I am still - for 5 more weeks a GP but then will have left the practice and be part time associate director and part time GPwSI in musculoskeletal medicine and chronic pain management
I belong to the educational boards of various organisations including the British Association of Sport and Exercise Medicine and British Institute of Musculoskeletal Medicine
When I am no longer a full timer I hope to devote more time to my triathlon and marathon career.
Nigel Fraser / GP Scarborough
Interest in cancer services
Currently engaged in an Msc in Primary Health Care at Leeds.
Committed Christian involved in local Scarborough church
Medical officer in Cumbria army cadet force, was in regular army in past.
Louise Gazeley / GP
Gordon Hayes / GP Scarborough town
GP Trainer
prospective HYMS training practice
DVLA medical examiner
Tillman Jacobi / GP York
Teaches undergraduates
Jennifer Manuel / GP Leeds
interests family planning
Chair of Northern Inter branch -family planning group trainer since 1997
Neal Maskrey FRCGP / Medical director of the national prescribing centre, Liverpool.
Previously I have been a GP on the East Coast of Yorkshire, Consultant in Primary Care Development for North Yorkshire HA and Clinical Editor of Clinical Evidence (BMJ Publications).
In 1993 I wrote the (first) MRCGP Workbook.
Sheena McMain FRCGP / GP principal (Leeds)
Course Organiser (Leeds VTS)
Senior Clinical Teaching Fellow and postgraduate programme manager, academic unit of primary care, university of leeds
Ramesh Mehay / GP Bradford
GP Trainer (Bradford)
Course Organiser (Bradford)
Currently engaged in a MSc in Medical Education
RCGP Faculty Board Member
Nick Price / GP (Homeless/Assylum Seekers Bradford)
Course Organiser (Bradford)
Gail Nichols / Flexible Career Scheme GP in Selby
Senior Teaching Fellow in Primary Care at the University of Leeds
Co-ordinator and assessor of the Primary Care component of the 4th year undergraduate Primary Care, Psychiatry and Public Health course.
Mark Purvis FRCGP / GP in Wilsden, Bradford.
Associate Director Yorkshire Deanery, GP Appraiser.
GPwSI in Ophthalmology.
Provost Yorkshire Faculty (RCGP)
Ella Russell / GP Bradford
Undergraduate training.
Registrar training
Clinical supervisor for out of hours training
Nurse practioner trainer.
OOH sessional doctor.
Special interest in diabetes
Hoping to become trainer next year.
Pam Rawal / GP (Bradford)
GPwSI Gastroenterology and Diabetes
Member of the exceptional cases committee (Bradford)
Training to become a trainer
Mal Smith / GP (Bradford)
GP Trainer (Bradford)
Chris Varnavides FRCGP / GP Leeds
College examiner
GP trainer
Nurse Practitioner facilitator/trainer
university undergraduate tutor
clinical assistant in dermatology
Mark Williams FRCGP / GP Selby
Trainer since 1995 on York VTS
Yorkshire Faculty RCGP Board member since around 1996
Special interest in Musculoskeletal and sports medicine.

THE MCQ

Introduction to the Course and the Exam

CONTENTS

Introduction to the Course and Exam

The Royal College of GPs - membership

What’s it all about then?

What do you get foryour membership?

Why do the MRCGP exam? What Have Other People Who Have Taken it Thought?

Icons Used In this Guide

Do You Want to Pass or Fail?

How To Pass

How to Fail R Neighbour, “How to Fail the MRCGP”, The Practitioner, May 2002 vol 246

Course Tutors