Abstract
The landscape of general practice exams has been pretty dynamic in recent years. While the Applied Knowledge Test has stayed fairly consistent the Workplace-based Assessment (WPBA) has been tweaked in various ways. The reduction in the number of required reflections has been welcomed by grass roots trainers and GPs alike, but the format remains fairly familiar. We all know that the main changes have come in the MRCGP ‘capstone’ consultation assessment of the Simulated Consultation Assessment (SCA). In my view the RCGP did a great job in rapidly transitioning from the Clinical Skills Assessment to the Recorded Consultation Assessment, but the latter was too unwieldly to be taken up long term. No matter what your views are about the SCA, it is with us for the time being.
From my perspective as a trainer in the crowded months of ST3, I honestly feel that getting the SCA out of the way is a priority so we can get to the ‘real’ learning. Once the exam is done, we can concentrate on preparing for the considerable challenges that come next. In the meetings of trainers’ groups, this is a common refrain among my peers. That said, I have described these challenges before in this column, so perhaps it is time, as trainers, we play our part in connecting exam preparation to real-life practice.
Doing so can be tricky for trainers. We can advise our trainees to focus on good consulting as a way of getting through the SCA, but breaking this down into components can be difficult. The consultation models of the past can be helpful but, in my experience, don’t always provide an easy framework to put into practice. Taken together with the increasing number of national and local guidelines, the whole landscape of good consulting can feel very unwieldly. Alongside the understandable exam stresses all our trainees go through, I think we need to find ways of keeping things simple.
You will have many concepts swimming around in your heads with the clock ticking as the assessment progresses. I have one important concept I suggest you refer to in the exam pressure cooker. Maintain your curiosity.
Professional curiosity in medicine is a concept that has been studied and discussed more broadly than in the UKGP context and it is an important component of performance often hindered by the pressurised working conditions of doctors (Bugaj et al., 2024). Indeed, more broadly, it is an important aspect of the work of social services and is cited as an important factor in the avoidance of medical harm (Jeffrey, 2023).
There are many times in my own working life as a GP where key clues to a diagnosis or the crux of the consultation have been picked up by probing a little more deeply into what I was hearing from patients. In particular, identifying something that was not necessarily a red flag but perhaps sounded strange or out of place. Sometimes we get this right, sometimes we can do better, but being curious often provides the answer. A measure of curiosity also makes me feel connected to the basic science underpinning our practice and is a reminder we are very far from knowing everything in bioscience and medicine.
Perhaps we find ourselves at a valuable intersection between preparing for ‘real-life’ as a GP and getting through the SCA. The cases in the exam have been carefully thought through, they are supposed to be challenging but not impossible. The cases are marked by experienced GPs who get a feeling for how interested you are in the case. This means a little curiosity goes a long way, particularly in the first few minutes of the case. Exam conditions naturally make us self-conscious and so a simple mantra is required to bring out the best person-focused consulting skills. As GPs we have permission to ask questions, so curiosity is a good concept to fall back on, particularly for those who want to increase their interpersonal skills scoring. For video game enthusiasts and GPs alike, treat each consultation like an open world that rewards a little exploration.
