The MRCGP CSA has been replaced during the current coronavirus pandemic with the Recorded Consultation Assessment (RCA). The RCA will be running until at least August 2021. As this is a new assessment, many registrars have asked how they can prepare for it. In this article, Dr Mukulika Wadud shares her experience of being in the first RCA cohort, and tips on how to pass.
2020 has been a very stressful time for everyone. One particular source of stress for me was my exam and CCT date. I was lucky (!) enough to be part of the first cohort for the new RCA assessment – and I passed! So I am here to let you know what my experience of that was, as well as what tips I feel would be beneficial for future candidates of this assessment.
The RCA (Recorded Consultation Assessment) is the new form of assessment that replaced the CSA exam, after the Covid pandemic led to cancellation of the March 2020 CSA dates. It involves the submission of 13 recorded consultations, with consent of the patients involved, and the aim of covering a wide range of clinical areas. You can submit any combination of video, audio and face to face consultations. I personally decided to submit all 13 cases as audio recordings. The RCGP then created a platform on the Fourteen Fish website where candidates could directly record their consultations (with consent) and also share the recordings with their supervisors for review and feedback.
My experience of the RCA will probably be very different to those sitting in the later cohorts, but all I can say is at the time it all felt very chaotic and stressful! Every week there was a new change and new updates to the assessment, and it seemed like us ST3s were just frantically trying to find out as much information as possible, while also trying to start recording – the Fourteen Fish platform was only released about a month into all of this so you can imagine the antics we got up to trying to record our consultations on camcorders and smart devices, and figure out things like consent etc.
My top tips for passing the RCA:
NB: these will apply more to remote consultations rather than face to face because when I was doing my recordings, Covid was still very prevalent, so at my training practice we were still only doing remote consultations (but bringing patients in for examinations when necessary).
1. Formulate a crib sheet and have a print out in front of you (stick it on your table or wall if you like!) – refer to this during your consultations so you know you are sticking to a good structure and not missing out anything important.
2. Have a table of the curriculum areas to hand so you can tick them off as you go and you also know what kind of cases you still have yet to record.
3. Record everything – they won’t all be ready for submission at first, but will be extremely valuable for listening/watching with your trainer, and picking up on things to improve on.
4. Ask your trainer to be brutally honest when reviewing your recordings! You need to be aware of any habits you have such as verbal tics, not responding to cues, talking too fast, etc, that you can then try to correct in future.
5. If you find a certain area within the interpersonal skills domain that you aren’t particularly strong in, think of some good statements you can say in that situation e.g. ‘thank you for sharing with me what’s been happening’, ‘I appreciate you are worried, I will try my best to help you and find out what is going on’, and so on.
6. Have a buddy or a small group of friends who you can meet regularly with (I met with mine over zoom after work) to review each other’s recordings and give constructive feedback – you can also use the RCA mark scheme for this (https://www.rcgp.org.uk/training-exams/mrcgp-exam-overview/-/media/04D7D236E6064B1BAD50226AF8330BC3.ashx )
7. Something I found useful, especially towards the end when I knew I needed better cases and had limited time, was coming into work during my scheduled educational sessions, to record more cases. I would ask reception to open a list for me but not to book any patients in. On the day I would look through everyone else’s lists, and pick out any cases that looked like they could give me good recordings. I’d then liaise with the respective doctor and reception, to get the appointment moved over to my list (ask reception to inform the patient beforehand)
8. Consent – we were all very confused about the rules and regulations around consent (who should take it, how should you take it, when/how many times is it needed etc), but Fourteen Fish is really great for this as it will sort out the consenting for you both before and after the recording, so that you don’t have to mention anything about it during the call.
9. Do your best to stay within ten minutes, use a timer if you can, and try to get to management by 6-7 minutes. Also with management, don’t forget safety netting and follow up!
10. Before each clinic and during catch up slots, look through your list and do some quick skim reading on the relevant topics on the NICE CKS website, to remind yourself of the differentials to think about and which red flags to check for, as well as management.
11. It can feel overwhelming and time-consuming when you are recording every consultation. Have a discussion with your trainer to see if it’s possible to get longer appointments or more catch up slots – if you don’t ask you don’t get!
12. Duty days are great for recording: urgent care cases are sometimes simpler to record as there will generally be one issue, and a fairly straightforward/differential. Thereafter you can quickly get to management, and you can also afford to be more doctor-centred for management.
13. Try not to type or scroll with your mouse during appointments, you’ll find it can be very distracting when watching the recordings back afterwards – another reason why longer appointments/more catch up slots are helpful: so you can keep up with your documentation.
14. Always pick up on cues and probe into them. If a patient sounds unsure of something or worried about something, verbalise this and explore it further. You’ll be surprised how often there may be a hidden back story to a patient’s reason for making an appointment. Addressing this will make the consultation run (and sound) much smoother, more patient-centred, and much more caring.
15. Lastly, this was a really good piece of advice I was given by a colleague at the time – if you are doing an audio recording, smile while you talk to the patient! You’ll be surprised what a difference it makes to the tone of your voice and your interpersonal skills.
Here is a list of the cases I submitted for my RCA:
- Low mood and anxiety
- Focal migraine
- Stage 1 hypertension in a young patient
- Pre-diabetes in a patient with hypertension and high cholesterol
- Emergency contraception for an epileptic patient
- Ear infection and confusion on a background of possible cognitive impairment
- Plantar fasciitis
- Depression with eating disorder
- Baby reflux
Resources I found useful for RCA
NICE Clinical Knowledge Summaries https://cks.nice.org.uk/
- I usually had this open during my clinics so that I could have relevant pages open during my consultations
Emedica CSA cases (65 cases) http://courses.emedica.co.uk/acatalog/MRCGP-CSA-Cases-Online.html
- I found it especially useful to have the mark schemes at hand when doing my consultations, so that I could use them almost like a check list for the sorts of questions I needed to ask during my data gathering portion, as well as good things to cover for management and counselling.
- My deanery also purchased these cases so that we could use them in facilitated group sessions where we role-played the cases.
RCGP website: https://www.rcgp.org.uk/training-exams/mrcgp-exam-overview/mrcgp-recorded-consultation-assessment.aspx
- There are a few documents and handbooks on this link that are useful to have a read of so you are aware of the rules and regulations of the assessment.
- This was very useful especially during the early stages of my RCA preparation, as it helped me organise myself and have a rough plan in mind.
I hope these tips are helpful – best wishes with your recordings and getting through your RCA!
Dr Mukulika Wadud passed her RCA with a score more than 15 marks above the pass standard, and is currently working as a salaried GP.
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