Abstract
History
The new MRCGP examination (nMRCGP) was introduced in August 2007 coinciding with the publication of the first RCGP comprehensive curriculum for general practice. Prior to this MRCGP was purely optional, with summative assessment being enough to register as a general practitioner (GP). The nMRCGP comprises an Applied Knowledge Test, Clinical Skills Assessment and Workplace-based Assessments. This new style of assessment hopes to test not only knowledge and competence but also performance and action meaning GPs qualifying today not only have to prove they know what to do but can actually do it in day-to-day clinical practice.
The consequence of these changes is that all GP trainees in the UK have contact with the RCGP and most will choose to become an ‘Associate in Training’ or ‘AiT’. With so many more trainees as associates of the college it was felt appropriate to form an AiT Committee to represent the views and opinions of trainees. The two registrar representatives from College Council (Dr Andrew Thompson and I) became chair and deputy chair respectively of the new committee and we held our inaugural meeting on 6 December 2007. There is an AiT representative from each of the 21 deaneries in the UK and meetings were held twice a year.
Last year was about establishing the committee and discussions centred around examination costs and problems with the ePortfolio. We also touched on wider issues affecting general practice such as the Darzi Next Stage Review and the job situation for newly qualified GPs. During the year, we were able to understand where the costs of the exam were coming from and conducted a series of interviews with the college treasurer, head of assessment and the ePortfolio team which are available on the New Professionals part of the RCGP website. We wanted to provide answers from senior figures within RCGP to the common questions coming from the trainees.
Present
This year I have the honour of chairing the AiT Committee. We have another enthusiastic group of representatives from all over the UK with some familiar faces re-elected from last year's committee but mostly new representatives with ST1, 2 and 3 being equally represented. There are now nearly 9000 AiTs and just over 36 000 members and associates of the RCGP in total meaning trainees make up almost a quarter of the membership. We are therefore an important body representing nearly a quarter of the membership. We still have two seats on College Council and we also have AiT representatives on all the boards involved with postgraduate training at RCGP. We have also recently been given a seat on the College Executive Committee which is an important body which meets a few weeks before council to discuss key issues for the college. We have increased the number of times we meet to three times a year. We have also established a ‘Google group’ which allows the committee to keep communicating between meetings. The following are some of the main concerns for 2009.
Five-year training
The Tooke enquiry into Modernising Medical Careers recommended that the length of general practice training should be increased from 3 to 5 years. General practice has in the past wrongly been seen as less than equal to other medical specialties. It was only as recently as 1998 that summative assessment was made compulsory to ensure a minimum level of competence for all those qualifying as a GP. The introduction of the new curriculum and nMRCGP has helped further to standardize GP training but the curriculum for general practice is the largest of all medical specialties and was designed to be delivered over 5 years. There is currently a drive to move more patient care out into the community. Patients like being treated closer to home and appreciate the familiarity of their local surgery. GPs repeatedly score very highly on patient satisfaction surveys. However, as the population ages and co-morbidities increase, the role of the GP becomes more complex and demanding. Comprehensive training in all areas of the curriculum and appropriate experience prior to independent practice are key to producing GPs of the future trained to cope with a more challenging and complex population. The RCGP is currently assessing the business case for the introduction of 5 year training and is due to submit a final report to the Department of Health. The case for increasing length of training seems to be strong; however, we are conscious the additional years should include practical, value-added experience and training rather than ‘more of the same’. Competencies in areas such as research and leadership could be addressed in more detail and opportunities to pursue special interests may be appropriate. We are heavily involved with this consultation as a key stakeholder and we have produced a report based on the views and feedback we have received on the issue of 5-year training from AiTs across the UK.
The Next RCGP Conference, Glasgow, 5–7 November 2009
Last year's conference in Bournemouth was well attended by AiTs. There was an AiT stream throughout the 3 days with workshops and breakout events. The AiT Committee Wessex Deanery also arranged an event specifically for AiTs on the Saturday afternoon following the conference, looking at issues such as exam preparation and career choices, which was a great success. This year's conference ‘Excellence in Practice’ is at the Scottish Exhibition and Conference Centre in Glasgow. We have already constructed a draft programmed which is aimed at AiTs. There will be five sessions for AiTs during the 3-day event which will range from exam preparation, how to make the most of your ST3 year, career opportunities and a ‘Question Time’ style discussion to address any trainee issues from the audience. The committee will be visible throughout the event and we will be hosting an AiT night out on the Thursday to give trainees from across the UK an opportunity to meet informally. I would encourage all AiTs to come along: it should be an interesting, informative and, above all, fun 3 days.
Examinations—costs and improvements
The cost of the examination is something the AiT Committee continues to monitor. Initially, we were keen to understand why the exams were so expensive. We conducted an interview with Dr Colin Hunter, Honorary Treasurer of RCGP. This can be found by going to www.rcgp.org.uk and then click on ‘GP training’, then ‘New Professionals’, then ‘Interview with’. Dr Hunter describes where the costs of the exam come from and reinforces the message from RCGP that nMRCGP exams are ‘cost-neutral’, i.e. the college does not make any profit from trainees sitting the examinations.
The RCGP has a Postgraduate Training Board (PTB) responsible for overall training and the quality and standards of the exam. We have an AiT representative on each of the PTB subcommittees, which address areas such as ePortfolio, Workplace-based Assessment and the curriculum. We will continue to feedback areas of concern to trainees and will ensure our voice is heard and improvements continue to be made.
Newly qualified GPs
The moment we stop being an AiT, we find ourselves in the increasingly uncertain world of the newly qualified G P. The AiT Committee recognizes that newly qualified GPs are currently a lost tribe in many respects. In the final year of training, AiTs are well supported with regular contact with their trainer, peer support at vocational training schemes and a job which has often been guaranteed for the 3 years running up to obtaining a Certificate of Completion of Training. We feel that the RCGP has a key role in supporting newly qualified GPs through those crucial first 5 years up to the first point of revalidation as well as for the rest of their careers and we are working on proposals for this.
International
The AiT Committee is keen not to forget the importance of an international perspective in general practice training. We are planning to work more closely with the Vasco da Gama movement of the World Organization of Family Doctors, which aims to promote communication and collaboration between young GPs across Europe, both in training and in their first few years after qualifying.
Local faculty engagement
As a committee within central college, we can only do so much and we rely on work at a local level to reach out to each AiT. We are encouraging each AiT representative on the national committee to interact with their local RCGP faculties to address AiT issues locally and also host events. You can contact your local AiT representative by going to the New Professionals part of the website (go to www.rcgp.org.uk and click on ‘GP training’) or you can e-mail me centrally at
Hopes for the future
As more diagnostics and treatments move from secondary to primary care, it is predicted that 50% of medical graduates will become GPs. The work of a GP is becoming more complex as the population ages and multiple morbidities increase. It is therefore important that GPs are appropriately trained and supported during training and throughout their careers by the RCGP. At a time of great change and opportunity, the AiT committee is a new committee representing a new generation of GPs. I hope that the AiT committee will develop into an increasingly influential body within the RCGP, so the views of trainees are supported at the highest level. As the next generation of highly trained specialist generalists, we are vital to the NHS.