Abstract
The Royal College of General Practitioners (RCGP) curriculum, approved in 2006, attempted to define the complex competences that are required by GPs in the National Health Service (NHS). It had been developed to reflect that, as a doctor in general practice, you do not deal simply with organ systems and diseases but with people and their problems. As a GP, you will have to manage every problem your patient presents to you, whether it is personally or by appropriate referral.
Therefore, the GP curriculum could never be an exhaustive list of all the possible learning outcomes relating to all the contexts in which you work as a GP. The meaning of the curriculum will increasingly be demonstrated by requiring you to be able to deal with problems, which may present differently in different types of patients with different implications and in ways that require different types of management.
Why is the GP curriculum changing?
A medical curriculum, if it is to remain relevant, has to be a living support for your learning, capable of change in response to:
the changing expectations of patients
the changing needs of the service
the changes in society
the ever changing knowledge of best practice and
the changing needs of trainees, trainers and educational supervisors
Since its development, the RCGP curriculum has been under constant review, and it has already undergone some changes (for example incorporating learning outcomes of the Medical Leadership Framework in 2010). Feedback from both trainees and teachers suggests that the original curriculum was too large and complicated, it was repetitive in places and the relationship of the various elements to each other was difficult to understand. As we now know more about how the curriculum is being used, this revision aims to improve it in ways that will help both trainers and GPs in training.
What is changing?
The statements
The main changes have been to the layout of the curriculum, rationalizing and combining statements where appropriate. The three types of statements are summarized in Fig. 1, as is the relationship of these three types of statement to each other.
Structure of the new version of the RCGP curriculum and the relationship between the three statement types.
‘Statement 1’, ‘Being a GP’, remains the ‘core statement’ and provides a full description of the knowledge, skills, attitudes and behaviours required of GPs in managing patients and their problems. This statement defines the six areas of competence and the three essential features of you as a doctor, which are used throughout the rest of the curriculum. It covers all aspects of general practice in generic terms, including the key skills of dealing with uncertainty, managing referral to secondary care and the ‘worried well’. It contains no specific clinical content outcomes at all.
The four contextual statements (Statements 2.1–2.4) explore particular aspects of general practice in greater depth. They contain learning outcomes in the ‘Areas of Competence’ and ‘Essential Features’ relevant to their topic but will not necessarily cover all of them. The content of these four statements is not new, but taken from the 2007 curriculum statements on clinical governance, patient safety, equality and diversity, evidence-based practice, research and academic activity and teaching, mentoring and clinical supervision. Within each statement, key points are demonstrated using case illustrations.
The clinical examples (Statements 3.01–3.21) apply the competences in ‘Being a GP’ to organ-based conditions as in, for example, the statements on Care of people with Eye Problems or Care of People with Metabolic Problems, or to population groups, as in the statements on Care of Older Adults and Men's Health. They are ‘examples’ and cannot be regarded as a complete list of every condition that you will encounter during your work as a GP. Working with these statements, you will learn how to work with the Core statement and enable you to work with any patient, any condition and any problem you are presented with in general practice. Each of these statements follows a common template, summarized in Box 1.
Common template used for the new Clinical Example statements of the RCGP curriculum
Key messages
Case illustration
Learning outcomes
Learning strategies
Learning resources
References
Acknowledgements
Language and information
The language used in the GP curriculum has also been simplified to make it more accessible. The content of the learning outcomes is largely unchanged but some have been reworded to improve clarity and others moved to more appropriate places. For example, there is now a common stem phrase for the six areas of competence:
‘This means that you as a GP should …’ and for the essential features of you as a doctor: ‘Examples of this are …’
The explanatory information provided has been updated in order to help you better understand the learning outcomes. Some of the educational nomenclature has been changed to make it more user-friendly and some new material added in response to national developments, for example, the medical leadership framework has been incorporated into the core statement. Finally, all learning outcomes are numbered to allow easy cross referencing so that, rather than duplicating material in different parts of the curriculum, a system of cross-referencing will be used.
When will the curriculum change?
The timescale for the change in the GP curriculum has been approved by the RCGP Postgraduate Training Board, and the proposed changes have been submitted to the General Medical Council and been approved. It will be implemented in full in August 2012 with all the statements in pdf format as you know already, and from August 2013, we hope to introduce the curriculum as an interactive web-based tool for your training.
Case study: The ‘GP trainee perspective’
As a GP trainee, I am excited to see the addition of the clinical leadership component to the GP curriculum. As GPs, we will be increasingly be expected to take a leading role in health care provision and the new curriculum has evolved to encourage us to develop and demonstrate these competences. As I will be qualifying in August, I aim to continue to use the curriculum as I venture out as a fully qualified ‘First5’ GP; the curriculum can help learning both during and beyond GP training.
Jaspreet Kaur Grewal, Deputy Chair of RCGP AiT committee
Will I be using the ‘new’ curriculum?
If you started GP specialty training before August 2012, you should continue to use the curriculum approved in 2006 (known as the 2007 GP curriculum). Those starting GP specialty training from August 2012 should use the 2012 version. For further information, the new 2012 version of the GP curriculum together with a new helpful user guide and the old version of the GP curriculum are and will remain available on the RCGP curriculum website: www.rcgp-curriculum.org.uk/rcgp_curriculum_documents.aspx.