MRCGP Recorded Consultation Assessment — the hidden fourth construct

Chris Williams

doi:10.3399/bjgp21X714689

The MRCGP Recorded Consultation Assessment (RCA) uses recorded consultations, ostensibly to assess three skills: inter-professional; data gathering, technical and assessment; and decision making and clinical management. These are entirely reasonable constructs for an assessment of readiness for safe independent practice.

However, the RCA has a hidden fourth construct: candidates must select cases that align with the examiners’ view of reasonable level of ‘challenge’. The latest Examiners’ Reports highlight that case selection continues to be a major issue, and some candidates have probably failed for this reason.

This alludes to a problem of construct validity: is the skill of identifying ‘suitable RCA cases’ really a prerequisite for safe, independent general practice? If not, can we justify continuing an assessment that has this hidden fourth construct as a prerequisite skill? Indeed, can ‘level of challenge’ of a GP consultation even be judged reliably? Even the latest candidate guidance appears somewhat vague in its definition. Furthermore, some candidates are likely to have greater difficulty collecting cases to choose from, with part-time trainees, those in smaller practices, and those in areas with large non-English-speaking populations likely to be at a particular disadvantage.

We are now past the early stages of COVID-19 and the ongoing use of the RCA is surely problematic, especially for high-stakes ‘fail’ decisions. Perhaps the RCA should instead be used as a screening test with unsuccessful RCA candidates then sitting the Clinical Skills Assessment (CSA). Smaller numbers of CSA candidates would ensure adequate social distancing. This approach would benefit potentially good candidates with fewer opportunities to record cases or who simply struggle to choose cases that align with the examiners’ particular view of ‘challenge’.