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MRCGP Examination

MRCGP Examination. Answer Structures & Grids. Consultation Models. Pendleton Neighbour Byrne & Long Stott & Davis. Pendleton “7 Tasks” 1. Define reason for attendance (patients ideas/concerns/expectations) Consider other problems Choose appropriate action for each problem

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MRCGP Examination

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  1. MRCGP Examination Answer Structures & Grids

  2. Consultation Models • Pendleton • Neighbour • Byrne & Long • Stott & Davis

  3. Pendleton “7 Tasks” 1 • Define reason for attendance (patients ideas/concerns/expectations) • Consider other problems • Choose appropriate action for each problem • Achieve shared understanding • Involve patient/accept responsibility • Use time/resources appropriately • Establish/maintain relationship with patient 1. Pendleton D, Schofield T, Tate D & Havelock P (1984) The Consultation: An Approach to Learning and Teaching (Oxford, OUP)

  4. Neighbour: “5 Checkpoints”2 • Connecting • Summarising • Handing Over • Safety Netting • Housekeeping 2. Neighbour R (1986) The Inner Consultation

  5. Byrne & Long3 • Doctor – Patient Relationship • Discover reason for attendance • Verbal/Physical Examination • Doctor/Patient consider condition • Doctor/Patient consider Treatment/Investigation • Terminate consultation 3. Byrne PS & Long BEL (1976) Doctors Talking to Patients (London HMSO)

  6. Stott & Davis4 4. Stott NCH & Davis RH (1979) The Exceptional Potential in each Primary Care Consultation JRCGP; 29: 201-205

  7. SOAP Subjective Objective Assessment Plan Pseudo-Latin Hx (History) Sx (Symptoms) Ix(Investigation) Mx (Management) Rx (Prescribe) Problem-Oriented Medical Records

  8. 5 Areas of General Practice • Clinical Practice – Health & Disease • Clinical Practice – Human Development • Clinical Practice – Human Behaviour • Medicine & Society • The Practice

  9. Health & Disease • Normal Range • Patterns of Illness • Natural History • Prevention • Early Diagnosis • Diagnostic skills/techniques • Management/Treatment

  10. Human Development • Genetics • Foetal Development • Childhood Development • Physical • Intellectual • Emotional • Normal Range

  11. Human Behaviour • Behaviour presenting to Doctor • Behaviour in Relationships • Behaviour in Family • Behaviour in Doctor-Patient Relationship

  12. Medicine & Society • Sociological aspects • Uses of Epidemiology • Organisation of Healthcare in UK • comparison with abroad • recent changes • Relationship between Healthcare services and other institutions of society

  13. The Practice • Practice Management • The PHC Team • Finance • Premises & Equipment • Medical Records • Medico legal issues • Research • Lifelong Learning

  14. Question Maker • Problem Definition • Management • Prevention • Communication • Organisation • Professional Values • Personal Development

  15. Advantages Disadvantages Applied to: Doctor Patient Practice PHC Team Relatives Community Healthcare General Public Situation Problems

  16. “HEIRS” History Examination Investigation Referral See again? “RAPRIO(P)” Reassure Advice Prescribe Refer Investigate Observe (Preventative) Clinical Problems

  17. Illness • Always answer in terms of: • Physical • Psychological • Social • Family/Community

  18. Patient’s request • Agree • Disagree • Negotiate

  19. Ethical problems • Utilitarianism • examines moral dilemmas • seeks to make decisions based on outcomes • applies to large populations • e.g. “the greatest good for the greatest number” • Deontological • applies to individuals • based on the duties of the doctor and the rights of the patient (and, of course, vice versa)

  20. Ethical solutions • ABCDE • Autonomy (Patient) • Beneficence • “above all, do no harm” • “do good where possible” • Confidentiality • Do not lie (Truthfulness) • Everybody else (Society)

  21. Doctor’s feelings • Awareness • Power • Anger • Guilt • Stress • Conflicts

  22. Breaking Bad News • “A KISS” • Anxiety: • try to elicit anxieties • Knowledge: • try to elicit knowledge • Information: • give information simply re treatment, prognosis, follow up • Sympathy: • give human contact (touch) • Support: • give practical help

  23. Dealing with Anger • “AFVER” • Avoid Confrontation • Facilitate Discussion • Ventilate Feelings • Explore Reasons • Refer/Investigate

  24. Marking Schedules • Model answer • Areas of Competence • Word Mapping

  25. Areas of Competence • Problem Definition • Management • Prevention • Practice Organisation • Communication • Professional Values • Personal/Professional Development

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