1. nMRCGP Assessments on the e portfolio
A summary for hospital clinical supervisors
Maggie Eisner

2. Components of nMRCGP
Applied Knowledge Test (machine marked test) – done in ST2 or ST3
Clinical Skills Assessment (simulated GP surgery) – done in ST3 in GP post
Workplace Based Assessment - mini CEX (COT in GP posts), CBD, CSR, MSF, DOPS
Learning log - including clinical encounters, tutorials and seminars, significant incidents, professional conversations (etc)
All components matched to curriculum headings and to competency framework

3. The e portfolio
Is the only record used in assessing trainee’s progress
Trainee responsible for keeping it up to date – but may need encouraging and reminding
Logon provided for Clinical Supervisor – sometimes the wrong name, e g specialty’s educational lead. Can be changed on e portfolio via VTS administrator Vicky at Field House
Clinical supervisor can view e portfolio (most of it)
Other health professionals can enter assessments via their GMC number or with electronic ‘ticket’ from trainee
Educational supervisor is GP educational supervisor for the 3 years

4. Assessment of progress
Educational Supervisor (GP trainer or Programme Director) meets trainee twice every 6m (month 2 and 4)
At 2nd meeting, ES evaluates evidence on e portfolio and enters Educational Review
ARCP once a year (in month 10) to agree to progression from ST1 to ST2, ST2 to ST3, or grant CCT

5. Number of assessments required before ES mtg in month 4
DOPS – any time in training –
Mandatory (there are others) : breast exam, Cx smears, female genital exam, male genital exam, prostate exam, rectal exam, bld gluc testing, simple dressings
Observers may be SpR, staff grade, nurses, consultants
miniCEX – at least 3 per 6m
15-min snapshot of doc-pt interaction
Observers may be staff grades, experienced SpR, consultant
MSF – 1 set of 5 per 6m in ST1, none in ST2
CSR – at least 1 per 6m, before ES mtg in month 4
CBD – at least 3 per 6m, preferably by experienced educator

6. Case based discussion – what and how?
Formal, structured exercise with preparation by trainee and assessor
Developed from the old MRCGP oral exam (designed to test whether trainees could consider scenarios and issues in breadth and depth)
Intended to find evidence of specific competencies, not test knowledge
Trainee selects 2 cases, gives copies of records to assessor in advance
Assessor selects one and
decides which competencies to look at
frames questions around the actual case, not exploring hypothetical events

7. Case based discussion – the competencies
Practising holistically
Data gathering and interpretation
Making a diagnosis/decisions
Clinical management
Managing medical complexity
Primary care admin and IMT
Working with colleagues and in teams
Community orientation
Maintaining an ethical approach
Fitness to practise

8. Case based discussion – rating
Expect progress from NFD to competent – ‘excellent’ is a description of a mature practitioner
Insufficient evidence – if you haven’t looked at that competency, or the case doesn’t address it
Needs further devel – rigid adherence to rules, superficial grasp of facts, can’t apply knowledge, little judgement
Competent – accesses and applies knowledge, sees things in context, conscious planning, ability to prioritise
Excellent – intuitive grasp of situations, doesn’t have to rely on rules, identifies underlying principles, understands context for applying knowledge

9. Case based discussion – making it useful
Prepare in advance
Get trainee to self rate and discuss whether you agree and why
Record a few details of the case (e portfolio has no specific slot for this, put in Feedback section) to
help educational supervisor to assess
help trainee to reflect
Encourage trainee to select case for next time which reflects the competencies they need evidence for

10. Further information
nMRCGP for Consultants – Elderly medicine
GP curriculum

11. Appendix
Detailed descriptions of the 12 competency areas and the criteria for the 4 grades
NB Each kind of assessment tests a different selection of competencies – e g CBD doesn’t include nos 1 (communication) and 9 (maintaining performance, learning and teaching)