The MRCGP RCA has replaced the CSA, and will be running until at least 2022 while a new assessment is being developed. In this article Dr Beita Khadem shares her experience and tips that helped her to pass with a score of 190 in the RCA – this was one of the highest scores in North West deanery / nationwide.
Although the RCA had been in the background of my mind since the start of my ST3 year, I began to give it some serious thought in January 2021, which is when I started recording. I recorded around 100 consultations in 8 weeks. I was consulting at 12.5 minutes when I started recording (so 12 patient contacts in a 2.5 hour clinical session), so there was plenty of opportunity to record.
The main resources I used included:
- The Emedica RCA Masterclass and Emedica full day RCA Intensive Preparation Course. I did these fairly early on when I started recording and found they made a great difference to the quality of my recordings thereafter. The masterclass covered the exam format, including recent changes to mandatory criteria and how examiners mark consultations. It also provided tips on communication and consultation skills. The interactive full day course was very useful – a high number of cases were covered – 25 in total. The cases and simulators were realistic and similar to real life cases you could encounter in practice. The 1:1 feedback provided was constructive. This meant that not only did I leave the course feeling more confident, but I was also aware of the key areas I needed to focus on moving forwards. This was funded by my deanery’s study budget so be sure to check whether your deanery will cover the cost too.
- The RCA Package by Dr Mark Coombe on Fourteen Fish. This was helpful in terms of explaining the marking schedule and mandatory criteria. The sample cases/videos allow you to understand how examiners award marks and ultimately help you to mark your own recordings. The most useful video was ‘How to Consult Well’ – this helped me develop a clear consultation style in 10 minutes. This was funded by my deanery’s study budget so be sure to check whether your deanery will cover the cost too.
- The Bradford VTS website. This website has some useful resources for the RCA. I found some telephone consultation frameworks which again helped me developed my own consultation style. There were also sample mark schemes which I later used to mark my own cases against.
Here are my 5 top tips which I hope you will find helpful:
- Get your trainer and practice on board with recording. RCA recordings tend to work best for new cases, so it is helpful if reception can put new problems on your list rather than follow ups and/or results. Let the GPs at your practice know that you are recording for the RCA, so they can let you know of any cases that may be good to record. This is especially useful if you are missing any mandatory cases. It is important to regularly speak to your trainer about how recording is going, in order make sure you don’t feel overwhelmed. In the last 2 weeks of recording, I got 2 blocks in my list. This allowed me to take cases from others’ lists if I thought they would be good to record or if I was missing any mandatory criteria.
- Record the vast majority of your consultations but not everything. I do think the more you record the more likely you are to get good material for submission. However, it is equally important to look after yourself and don’t get burnt out – this could happen easily if you record all day every day! I never used to record more than 4 cases in a session.
- Keep a timer on your desk and wear a telephone headset. This is a logistical tip but made a massive difference to my recordings. I bought a cheap timer online for around £5. This meant that I knew when my recording starts (i.e. after ‘how can I help you today?’) and when to move on from data gathering to clinical management. The headset meant that there was less scope for any network connection difficulties and allowed me to make brief notes during the consultation if needed.
- Develop your own consultation style. This is something that will take a while, which is why I’d recommend at least 6 weeks to record. Use a range of resources to help you learn more about how to consult. I personally found that starting with an open question, exploring the psychosocial impact of the problem and getting ICE done early worked better (rather than data gathering first) but this is a personal preference. Once you find your own style you will find that consultations flow with ease and you are less stressed about hitting the 10 minute mark!
- Listen to your recordings and mark them. I used to allocate a couple of hours in the evenings to listen to my recordings. I used the Bradford VTS sample mark schemes to give my consultations a score out of 9 and ultimately only submitted those that I thought would score 6 or higher.
After much deliberation, the final cases I submitted were:
- Parental concerns about a child’s anxiety
- New cough and shortness of breath
- A child with headaches
- Abdominal pain and bloating
- Low mood and stress at home and work
- Difficulty swallowing
- Shoulder pain affecting ADLs
- Flare of osteoarthritis affecting ADLs
- A new case of depression and thoughts of self harm
- Difficulty conceiving
- Primary amenorrhea
I wish you all the best of luck with your preparation and recording. In the words of Alexander Graham Bell, remember that ‘Before anything else, preparation is the key to success’!
Dr Beita Khadem is now a salaried GP in West Yorkshire and passed the RCA on her first attempt in March 2021 with a score of 190 – more than 45 marks above the passmark! She was a GP trainee in the North West Deanery and completed her training in August 2021.