The Orals

1. The Orals Aim is to test candidates decision making skills in defined areas

2. DOMAINS OF COMPETENCE • A Factual knowledge • B Evolving knowledge: uncertainty, hot topics, qualitative research • C Evidence base, knowledge of literature, quantitative research • D Critical appraisal, interpretation of literature, principles of statistics • E Application of knowledge, justification, prioritising, audit • F Problem solving (general applications) • G Problem solving (case specific), personal management ) • H Personal care: matching principles to individual patients • I Written communication • J Verbal communication, the consultation process • K The practice context: team issues, practice management, business skills • L Regulatory framework of practice

3. DOMAINS OF COMPETENCE • M The wider context: medico-political, legal, societal issues • N Ethics, trans-cultural issues • O Values and attitudes: Integrity, consistency, caritas • P Self-awareness, insight, reflective learning, the doctor as a person • Q Commitment to maintaining standards, personal and professional growth, CME

4. Testing of domains by module • Written paper - A B C D E F G H I J K M N P • MCQ – A B C D G L N • Consulting skills – G H J O • Oral – D E F G H J K M N O P Q

5. THE ORALS CONTENT • Areas of competence • Communication, • Professional Values, • Personal and Professional growth • Context • Care of patients, • Working with colleagues, • Society in general, • Personal responsibility

6. Pitfalls for examiners • First impressions • Appearance • Contrast with previous candidates • PLU • Reflection of own fallibility • Rays of sunshine • Grading the last answer • Making (simplistic) unidirectional judgements

7. Pitfalls for candidates • Not getting there • Not exploiting the pitfalls for examiners • Non verbal communication • Not realising that you are expected to debate • It’s the fluffy stuff • Not thinking broadly - OICJ

8. THE ORALS FORMAT • Edinburgh 2-3 days, then London 5-10 days • Friendliness, decorum, informality, equal opps • 2 vivas x 20mins, 5 topics per viva (case specificity of performance) • 2 examiners, 3rd examiner or video camera? • “Significant personal & professional knowledge” • Neither pair knows your grades in other modules, 2nd pair do not know your mark in 1st viva until the quartet meets

9. THE ORALS HANDLING THE QUESTIONS • Rehearse control phrases • Use skeletons to frame response • Be prepared for • interuptions, • an early finish, • the doom cloud of failure • Prepare model answers for hot topics QUOTE FROM THE LITERATURE WHERE IT’S APPROPRIATE

10. Marking Scale • Outstanding • Very well informed, coherent, rational, consistent, critical. Stretches the examiner. Supports arguments by reference to the evidence, both published and topical. Can reconcile conflicting views and daa. Very robust justification of proposed action. Impressive exploration of ethical issues.

11. Marking Scale • Excellent • Confident and fluent candidate. Rational consistent. Impressive range of options / implications. Well informed, uses rigorous and well-substantiated arguments. Integrates understanding of the topic into their reasoning when justifying decisions. Relevant ethical issues explored in depth.

12. Marking Scale • Good • Definitely passing candidate. Generally rational, consistent, and fluent. Good options / implications. Sound evidence base, makes acceptable rather than robust or rigorous arguments. Can analyse their understanding of essential issues when justifying decisions. Important ethical issues recognised and explored.

13. Marking Scale • Satisfactory • Examiner is comfortable with candidates adequacy at MRCGP level. Main options and implications seen and understood, but no sophistication of approach. He/she is solid and can apply their understanding of the essential issues when decision making. Informed by some evidence. Some ethical issues recognised.

14. Marking Scale • Borderline • Examiner not comfortable with candidate’s adequacy for Membership. Not enough justification of decisions. Can understand the relevance of the topic but decision making skills are, on balance, not quite acceptable. Superficial appreciation of ethical aspects.

15. Marking Scale • Not adequate • Cannot discuss topic in a depth appropriate for a Member of the College. Can recognise essential issues but examiner not satisfied with candidate’s decision-making skills. Inflexible, superficial and needs prompting. Limited range of options seen. Very limited use of evidence. Unable to apply ethical principles.

16. Marking Scale • Unsatisfactory • Cannot discuss topic in a depth appropriate for a doctor entering general practice. Cannot recognise essential issues. Poor decision-making skills. Almost no evidence for approaches. Options rarely seen. Is unaware of ethical dimension.

17. Marking Scale • Poor • Cannot discuss topic in a depth appropriate for a medically-qualified person. Inconsistent. Cannot recognise essential issues and unable to see range of options. No evidence of rational decision-making or ethical considerations.

18. Marking Scale • Dreadful • Candidate worse than poor, adopts such arbitrary approaches as to affect patient care adversely.

19. Reasons for failing • Disorganised / inconsistent • Slow / ponderous / had to be led • Garrulous and verbose • Superficial / shallow / lack of justification • Difficult to understand the points the candidate trying to convey • Not recognising dilemma • Not seeing range of options • Unable to apply knowledge • Rigid & inflexible • Unable to apply ethical framework • Lack of self awareness

20. Reasons for failing • No evidence of patient-centredness • Unable to take personal responsibility • No evidence of empathy & caring • Difficulty making decisions • Lack of evidence to support decisions • Failed to see issue at all

21. Summary If you are sitting all 4 modules don’t relax (or give up) after the written papers. PPPPPP Technique is even more critical in the orals. Practice pays off

22. “When the bell goes, stop talking and wait to be told to leave. Say ‘thank you’ and leave quietly and promptly. Do not grimace, weep or look desperate. Do not torture yourself by dwelling on instances of ‘Oh dear’ or ‘Never mind’ that the examiners have said to you. Clear your mind, and move on.” Cascarini L, Irani M. JRSM 2005; 98: 174 – 7.