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Life & Times

The MRCGP Recorded Consultation Assessment: time to drop 10 minutes as standard?

Greg Irving
British Journal of General Practice 2021; 71 (703): 71. DOI: https://doi.org/10.3399/bjgp21X714725
Greg Irving
Edge Hill University, Ormskirk, West Lancashire. This article was written on behalf of St Helens GP trainers group, St Helens, Merseyside. Email:
Roles: Senior Lecturer in General Practice
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  • For correspondence: irvingg@edgehill.ac.uk
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Why do we continue to examine GP trainees at 10 minutes when the RCGP itself has called for longer GP consultations?

The recently announced changes to the MRCGP in response to the COVID-19 pandemic has seen the replacement of the Clinical Skills Assessment (CSA) with the Recorded Consultation Assessment (RCA).1 Yet the guidance on the length of the face-to-face consultations to be submitted in the assessment remains at 10 minutes — even for complex cases.

Arguments put forward in the past suggest that the 10 minutes examination exists because:

  1. The exam only assesses the face-to-face element of the consultation and not those activities that take place either side of the consultation such as preparation and documentation

  2. The exam must prepare the candidate to practice anywhere in the UK including those practices that offer 10 minutes, and;

  3. The examination has been validated against the standard of a 10 minute consultation.

The argument that the examination only assesses the face-to-face element of the GP consultation highlights a more fundamental problem in medical education, health service research and policy — that there is no agreed definition of what constitutes ‘the consultation’. Precision is important and without such definitions it remains unclear whether we are measuring and talking about the same intervention in policy and assessment. In two systematic reviews of GP consultation length, a wide range of approaches were used to define and measure consultation length.2,3

No trial or observational study fulfilled the TIDieR guidance how an intervention should be described.

We would argue that definitions of the full range of GP consultation types are needed to be more precisely defined in accordance with the TIDieR framework.4

The argument that the exam prepares the candidate for practice anywhere in the UK including those practices that offer 10 minutes as standard is inconsistent with College reports even prior to COVID-19 that states that the 10 minute consultation is not safe and effective for current practice where multimorbidity and complexity is now the norm.5,6 Asking candidates to focus on one problem only creates an artificial scenario and contradicts evidence on best practice.7 It may also encourage gaming where patients may be coached prior to the consultation to only discuss one problem.

The COVID-19 pandemic has also seen the widespread introduction of a digital first approach and total triage systems where most histories are taken by telephone or video and the face-to-face element reserved for physical examination only.8 Here the total consultation time for a single presentation may exceed 10 minutes.

If an examination that is representative of current UK practice is the intention then it would be useful to align this with data from observational data for complex presentations, for example, from the RCGP Workload observatory, CPRD, QResearch or NHS digital.

MUTUALLY BENEFICIAL

The final point that the examination has been validated against a 10 minute standard is not insurmountable. Validating the examination against 15 minutes or longer for those cases with multimorbidity and complexity would be a logical place to start.

In the long-term this could bring benefits to patients such as more accurate diagnosis of mental health problems and more opportunities for health promotion and reducing admissions for some ambulatory sensitive conditions such as diabetes. Crucially, it could also bring benefits to GPs including reduced burnout and improved job satisfaction.2,3 The COVID-19 pandemic has presented us with opportunities to decide which activities we should discard and what activities we wish to amplify.

The new RCA change offers an opportunity to define what is we mean by consultation length, align policy and assessment, promote safe and effective practice and reflect current UK practice.

Footnotes

  • This article was first posted on BJGP Life on 29 December 2020: https://bjgplife.com/MRCGP

  • © British Journal of General Practice 2021

REFERENCES

  1. 1.↵
    1. Royal College of General Practitioners
    (2020) MRCGP: Recorded Consultation Assessment (RCA). https://www.rcgp.org.uk/training-exams/mrcgp-exam-overview/mrcgp-recorded-consultation-assessment.aspx (accessed 6 Feb 2021).
  2. 2.↵
    1. Irving G,
    2. Neves AL,
    3. Dambha-Miller H,
    4. et al.
    (2017) International variations in primary care physician consultation time: a systematic review of 67 countries. BMJ Open 7, e017902.
    OpenUrlAbstract/FREE Full Text
  3. 3.↵
    1. Wilson AD,
    2. Childs S,
    3. Gonçalves-Bradley DC,
    4. Irving GJ
    (2016) Interventions to increase or decrease the length of primary care physicians’ consultation. Cochrane Database Syst Rev doi:10.1002/14651858.CD003540.pub3.
    OpenUrlCrossRef
  4. 4.↵
    1. Hoffmann TC,
    2. Glasziou PP,
    3. Boutron I,
    4. et al.
    (2014) Better reporting of interventions: template for intervention description and replication (TIDieR) checklist and guide. BMJ 348, g1687.
    OpenUrlAbstract/FREE Full Text
  5. 5.↵
    1. Royal College of General Practitioners
    (2019) Fit for the future: a vision for general practice, https://www.rcgp.org.uk/policy/fit-for-the-future.aspx (accessed 6 Feb 2021).
  6. 6.↵
    1. Royal College of General Practitioners
    (2013) Medical generalism, https://www.rcgp.org.uk/policy/rcgp-policy-areas/medical-generalism.aspx (accessed 6 Feb 2021).
  7. 7.↵
    1. National Institute for Health and Care and Excellence
    (2017) Multimorbidity and polypharmacy. Key therapeutic topic [KTT18], Updated: 1 September 2019https://www.nice.org.uk/advice/ktt18 (accessed 6 Feb 2021).
  8. 8.↵
    1. Oxford-Royal College of General Practitioners
    (2021) Clinical Informatics Digital Hub, https://orchid.phc.ox.ac.uk/index.php/rcgprscworkloadobservatory/ (accessed 15 Feb 2021).
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British Journal of General Practice: 71 (703)
British Journal of General Practice
Vol. 71, Issue 703
February 2021
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The MRCGP Recorded Consultation Assessment: time to drop 10 minutes as standard?
Greg Irving
British Journal of General Practice 2021; 71 (703): 71. DOI: 10.3399/bjgp21X714725

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The MRCGP Recorded Consultation Assessment: time to drop 10 minutes as standard?
Greg Irving
British Journal of General Practice 2021; 71 (703): 71. DOI: 10.3399/bjgp21X714725
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