Transcript nMRCGP

nMRCGP
Dr Mark Metcalfe
nMRCGP
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Money
AKT
CSA
Money
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Become AiT
AKT
CSA
Fee to PMETB
TOTAL
£492
£360
£1260
£780
£2892
Course
TOTAL
£660
£3552
Money
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If you have to retake your exams….
£5282
These are figures for this year….
They might increase
Registrar pay
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Basic salary
plus 50%
London weighting
£30660
£15330
£2162
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TOTAL
£48152
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Exams
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AKT
Computer marked ‘multiple choice’ paper
CSA
Practical assessment of consulting skills
AKT
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Relevance:
The AKT should be relevant to general
practice; any topic covered can be one which
occurs commonly or one which is significant
but less common
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High prevalence: Low impact e.g. URTI
High impact: Low prevalence e.g. meningitis
Topical: e.g. Controlled drugs
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Sources
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Clinical Evidence
Cochrane Database
BNF
GP Curriculum
NICE
SIGN
BMJ Review articles & original papers
BJGP
DTB
This is your friend
AKT
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Core clinical medicine and its application to problem
solving in a general practice context
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Critical appraisal and evidence based clinical practice
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80% of items
10% of items
Ethical and legal issues as well as the organisational
structures that support UK general practice
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10% of items
Stuff no one bothers with but
features heavily in the exam…
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Regulatory frameworks
Legal aspects, e.g. DVLA
Social services, e.g. Certification
Professional regulation, e.g. GMC
Business aspects, e.g. GP contract
Prescribing, e.g. Controlled drugs
Appropriate use of resources, e.g. drugs
Health & Safety, e.g. needlestick injury
Ethical, e.g. Mental capacity, consent
Essentials for AKT
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Know latest guidelines
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Know the BNF
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Know basic stats
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Your core medical knowledge is probably
already sufficient.
AKT
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1164 candidates
Mean score
Pass mark
Pass rate
76.5%
69.85%
83.7%
Pass rate ST2
Pass rate ST3
76%
88%
AKT – Areas of weakness
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Asthma
COPD
Certification
Travel health (vaccinations and commonly
used drugs)
Management of dermatological problems
National screening programs
CSA
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You must bring:
BNF, Stethoscope, Ophthalmoscope,
Auroscope, Thermometer, Patella hammer,
Sphygmomanometer (aneroid or electronic),
Tape measure, Peak flow meter and
disposable mouthpieces
There are no spares at the exam centre
Anything else you need is provided
CSA
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You have your own room.
You have a list of patients – your ‘surgery’ for
the morning.
The list contains brief info about the patient.
It may or may not include PMH, drugs etc.
You probably wont know why they are coming.
You have never seen the patient before – but
colleagues might have.
CSA
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Buzzer will sound and patient and examiner
come in.
You have 10mins after which buzzer will sound
again. Anything said or done after this will not
count. The patient and examiner then leave.
There is no ‘1min/2min’ warning buzzer.
There is a 2 minute break between patients.
There is a 15min break after 7 patients seen.
CSA
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The examiner sits out of your line of site.
Examiner does not participate in the
consultation. Ignore them.
All patients are played by actors who have
been well briefed beforehand
They will almost certainly not have any
physical signs to elicit on examination
CSA – Exams and investigations
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If you want to examine the patient say so and
say what you are going to examine.
If they are testing this exam technique they will
let you go ahead.
They will then give you the exam findings.
If they are not testing this exam they will just
give you the findings and tell you not to
examine.
They will only give you results of exams you
say you will do.
CSA – Exams and investigations
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Examination is what you would normally do as
a GP.
This means a lot of it can be done with the
patient sitting in the chair.
It does not have to be exhaustive.
Eg. Chest exam – percussion and auscultation
is fine.
CSA – Exams and investigations
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Any investigation results will be on the table in
front of you or, more likely, will be brought in by
the patient.
It will list normal levels so you don’t have to
remember them.
Abnormal findings will be common GP tests.
Eg. Hb, HbA1c, urinalysis etc.
It will not be anything obscure.
CSA – Management plans
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If you want to prescribe a drug you don’t have
to write a prescription
All you need do is say
Eg. I will give you omeprazole 20mg once a
day.
This is as good as having written it.
There are prescription pads on the table. Do
not let these distract you.
CSA – Management plans
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DON’T WRITE ANYTHING DOWN
There is no time
The prescription will be marked
There is no penalty for just saying it
You have to say what you are giving anyway
CSA – Management plans
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The same applies for blood tests and sick
notes and any other forms you might write.
Just say what you will do.
If you want to make a referral, ask the patient
to wait in the waiting room and you will bring
the letter/form out to them.
Leaflets can be ‘collected from reception’
CSA
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You have 10 minutes per case.
‘Shows poor time management’ is a reason
they can fail you at the station.
And they will.
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You MUST be consulting at 10 minutes.
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CSA
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Each case is marked in 3 domains :
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Data gathering, examination and clinical
assessment skills
Clinical management skills
Interpersonal skills
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All domains have equal weighting
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Do not spend 8 minutes on history and examination –
you will fail the station.
CSA
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But those domains have no meaning…
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What are they actually looking for?
CSA
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DATA-GATHERING, TECHNICAL &
ASSESSMENT SKILLS
Gathering & using data for clinical judgement
Choice of examination
Investigations & their interpretation
Demonstrating proficiency in performing
physical examinations & using diagnostic and
therapeutic instruments
CSA
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CLINICAL MANAGEMENT SKILLS
Recognition & management of common
medical conditions in primary care
Demonstrating a structured & flexible
approach to decision-making.
Demonstrating the ability to deal with multiple
complaints and co-morbidity.
Demonstrating the ability to promote a positive
approach to health
CSA
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INTERPERSONAL SKILLS
Demonstrating the use of recognised
communication techniques to gain
understanding of the patient's illness
experience and develop a shared approach to
managing problems.
Practising ethically with respect for equality &
diversity issues, in line with the accepted codes
of professional conduct.
CSA
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The grades will be on a four point scale:
Clear Pass
Marginal Pass
Marginal Fail
Clear Fail
There are no merits or ‘grades’ at the end for
the exam as a whole.
You pass or fail.
I Failed?
Data Gathering
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Disorganised and unsystematic in gathering
information from history taking, examination and
investigation
Does not identify abnormal findings or results or fails to
recognise their implications
Data gathering does not appear to be guided by the
probabilities of disease
Does not undertake physical examination competently,
or use instruments proficiently
Clinical management
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Does not make appropriate diagnosis
Does not develop a management plan (including
prescribing and referral) that is appropriate and in line
with current best practice.
Follow-up arrangements and safety netting are
inadequate
Does not demonstrate an awareness of management
of risk, and health promotion
Interpersonal skills
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Does not identify patient’s agenda, health beliefs &
preferences / does not make use of verbal & nonverbal cues
Does not develop a shared management plan or clarify
the roles of doctor and patient
Does not use explanations that are relevant and
understandable to the patient
Does not show sensitivity for the patient’s feelings in all
aspects of the consultation including physical
examination
Global
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Disorganised / unstructured consultation
Does not recognise the challenge (e.g. the
patient’s problem, ethical dilemma etc.)
Shows poor time management
Shows inappropriate doctor - centeredness
Essentials for CSA
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Be in general practice for a few months
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Consult at ten minutes