Pass MRCGP RCA With Arora

The RCA GP exam is a type of recorded assessment, which is essential if  GP trainees wish to qualify as General Practitioners in the UK. 

The format of the assessment requires candidates to submit 13 real-life consultations from within their normal working environment.

Consultations can be face-to-face, video or telephone consults and can be recorded from within a Practice or from your own home – depending on how you are currently working.

Chosen cases are submitted to a central platform created by Fourteen Fish and marked by examiners. A different examiner will examine each case.

Cases should be continuous with no breaks or edits. Only the first 12 minutes of the consultation recording (minus time for consent) will be marked.

Booking is via the RCGP website.

MRCGP stands for ‘Membership of the Royal College of General Practitioners’, which means an MRCGP qualification (if passed) qualifies a GP trainee to join the Royal College and practice in the UK as a General Practitioner. 

This type of qualification is a postgraduate course, run by the Royal College of General Practitioners (RCGP). 

The RCGP is responsible for all educational elements that trainee doctors require to qualify in general practice. Now, all trainees who want to practice as GPs in Britain must gain an MRCGP qualification first. 

The two main exams allowing trainees to do this are the AKT (Applied Knowledge Assessment) and the RCA (Recorded Consultation Assessment). These are designed to test candidates’ clinical knowledge and skills as well as their ability to work under the conditions of a General Practice environment and effectively communicate with patients.

The aim should be to submit cases demonstrating as much breadth of the curriculum as possible, with no more than two cases from a single curriculum area. It is suggested to aim for new presentations (as opposed to follow-ups), choosing cases that demonstrate the level of an ST3 GP trainee.

The RCGP have some mandatory cases:

– A case involving a Younger Person (16 years or younger)

– A case involving an Older Adult (65 years and above)

– A case including a Mental Health concern

– A long-term condition eg cancer, multi-morbidity or disability 

– A case involving an acute problem (urgent investigation or referral)

– A case involving Maternal or Reproductive Health

There are also some ‘recommended’ features including:

– Having no more than two cases in a particular topic area

– Having a variety of spread of clinical areas and complexity

Your educational supervisor will need to verify that it is all your own work prior to submission.

The RCA is the second part of the MRCGP examination process, the first being the MRCGP AKT exam. Candidates can submit their recorded consultations for the RCA only in their ST3 year or from their third year of GP training.

The pass rate for the MRCGP RCA is slightly higher than the AKT. For 2022 it has been above 80%.

The upcoming (2022/2023) RCA dates are as follows:

September 2022 RCA

Apply: 10th August 2022- 23rd August 2022
Submissions by: 21st September 2022
Results: 20th October 2022

November 2022 RCA
Apply: 4th October -18th October 2022
Submissions by: 28th October 2022
Results: 15th December 2022

Jan 2023 RCA
Apply: 13th December 2022 – 3rd January 2023
Submissions by: 24th January 2023
Results: 23rd February 2023

The RCA tests core aspects taken from the RCGP Curriculum, specifically:

– Knowing yourself and relating to others
– Applying clinical skill and knowledge
– Managing couples and long-term care
– Caring for the whole person and wider community

Each case is marked across three domains, with each domain gaining a CLEAR PASS, PASS, FAIL or CLEAR FAIL outcome. The three domains are:

– Data gathering.
– Clinical management.
– Interpersonal skills.

Data gathering assesses your ability to first gather, and then utilise data from various sources. These include relevant history taking and examination skills, as well as interpretation of results and clinical letters. Data gathering is not restricted to clinical issues – understanding the patient’s thoughts, as well as impact on their psychosocial life is also part of understanding key issues of the case. Being efficient, relevant and systematic is important as time can quickly add up – leaving enough time for management is key to using the data effectively.

> Takes a focussed history to allow for a safe assessment to take place
> Elicits and develops relevant new information
> Rules in or out serious or significant disease
> Considers and/or generates any appropriate diagnostic hypotheses
> Explores where appropriate the impact and psychosocial context of the presenting problem
> Plans, explains and where possible, performs appropriate physical/mental examinations and tests
> Appears to recognise the issues or priorities in the consultation

Clinical management assesses your ability to use the data that you have elicited, both in terms of managing the clinical problem as well as managing the situation as a whole. Clinical decision-making, managing patient expectations, health promotion and effective use of resources may feature here.

> Appears to make a safe and appropriate working diagnosis/es
> Offers appropriate and safe management options for the presenting problem
> Where possible, makes evidence-based decisions re prescribing, referral and coordinating care with other healthcare professionals
> Makes appropriate use of time and resources whilst attending to risks
> Provides realistic safety netting and follow up instructions appropriate to the nature of the consultation

Interpersonal skills run throughout the ten-minute consultation, assessing your ability to communicate effectively and with a patient-centered approach. It is not simply ‘being nice to the patient’ – adapting techniques for different situations is key – done so in a fluid, non-rehearsed way. It also focuses on areas such as ethics, equality and diversity, explanations and attitude.

> Encourages the patient’s contribution, identifying and responding to cues appropriate to the consultation
> Explores where appropriate, patient’s agenda, health beliefs & preferences
> Offers the opportunity to be involved in significant management decisions reaching a shared understanding
> When undertaken, explains and conducts examinations with sensitivity and obtains valid consent
> Provides explanations that are relevant, necessary and understandable to the patient

1. Keep to a structure

Candidates often slip up when recording their patient sessions by losing sight of the overall purpose and direction of their consultation. This can happen easily, as real patient consultations are not rigid or predictable. For instance, a patient may ask you a question you didn’t anticipate, or may need you to expand on one particular area in more detail. 

To help combat this, and make sure you hit key goalposts during a consultation, keep a visible ‘crib sheet’ in front of you during all your patient sessions. That way, you can make sure you’ve covered everything you need to, and return to areas you might have bypassed or that need clarifying. This is easier when opting to submit audio consultations, or even video consultations if you place the sheet behind the camera or in a position where it doesn’t impact your view of the patient. However, you can also bring a clipboard or folder into face-to-face consultations too. 

2. Record everything 

Recording practice sessions, whether with your supervisor, peers, friends, or even yourself, can be hugely beneficial when it comes to knowing how to communicate effectively and apply your knowledge laterally. Assessing your performance by re-watching recordings can also be a very effective tool to help you spot and work on areas of improvement, as well as get used to the feeling of being recorded in time for your real consultations. 

3. Remember your interpersonal skills 

The RCA requires GP trainees to not only demonstrate not only their clinical knowledge, but also their interpersonal skills. 

This means your consultations must show that you’re able to communicate effectively with patients, and gather information needed to make your assessment/ diagnoses. It also means that you must show you’re able to sooth and provide a comfortable environment for patients, particularly in cases where the issue is an urgent one. 

If you feel less comfortable with this area, it may be beneficial to try keeping a note of key phrases and responses which you can come back to at points during your session. 

For example, this may be: “I know this may be difficult to share this with me, so thank you for talking to me about it”, or, “Now that I have all this information I’ll be able to work to find out what the next steps are for you”. 

The key thing GP trainees should bear in mind when preparing for the MRCGP tests, is that supervisors are looking for more than them simply knowing everything they need to become a practicing GP. Candidates must also show that they can apply this knowledge in a way that is professional and provides help and advice to patients in need of care. Make sure you are always keeping this in mind with your revision and preparations. 

Our All-in-One RCA Package includes a full online course, 2 audiobook courses, online case bank, data gathering flashcards, explanation flashcards and a large RCA wall poster – meaning you have everything you need to help pass RCA the first time around. 

Our audiobook bundle include sections on ‘how to explain’ problems to patients as well as recognise 100 common illnesses and diseases, while our RCA-90 online course focuses on how to choose, record and format your patient consultations, using 90 examples.