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MRCGP Orals

MRCGP Orals. M Ather. RCGP. Setting. RCGP Make sure you arrive at least an hour early Knightsbridge - nearest tube station Usually in two big rooms Screens between tables Plenty of noise. Format. 2 tables 2 examiners per table 20 minutes each table, 5 min break

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MRCGP Orals

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  1. MRCGP Orals M Ather

  2. RCGP

  3. Setting • RCGP • Make sure you arrive at least an hour early • Knightsbridge - nearest tube station • Usually in two big rooms • Screens between tables • Plenty of noise

  4. Format • 2 tables • 2 examiners per table • 20 minutes each table, 5 min break • 5 questions per table, 4 min / question • Alternate questions

  5. Questions Grid

  6. Example of questions

  7. What to demonstrate • Decision making skills • Not dangerous • Can see both sides of an argument • Make a decision • Justification of your answer

  8. Marking • O outstanding • E excellent • G good • S satisfactory • B borderline (aggregated >4Bs to pass) • N not adequate • U unsatisfactory • P poor • D dreadful

  9. Tips on technique • Before answering, pause briefly to digest • Ask for clarification if you don’t understand • Be patient-centred in reaching decisions • Flexible…………You…………..Rigid

  10. Must know • Ethical framework • Fraser / Gillick competence • Confidentiality • GMC Good Medical Practice • Underperformance – how to handle? • CPD • Leadership skills • Consultation models • End of Life decisions- AD, Euthanasia, Death certification • Bodies: PCT, LMC, GPC, NPSA, MDU, GMC

  11. Handling Underperformance

  12. Structure your answer Patient Doctor (duties of a doctor GMP) Practice PCT Wider: NHS, politics, society, media Ethical Medicolegal EBM

  13. Reasons for failing • Slow response, needing lot of prompting and leading • Shallow & superficial answer, decision making lacking justification • Inability to consider range of options in order to justify rational approach to decision making • Difficulty in recognising the dilemmas posed by the question • Difficulty / inability to make a decision

  14. Summary • Pause / digest question • Apply framework • Demonstrate awareness of both sides of an argument • Make a decision • Justify your answer • Not too rigid / flexible • Practice……..

  15. Consultation Models • Know a few • Know them well • Salient features • Why you like this the most? Justify

  16. Pendelton’s“Seven tasks of consultation” • Define the reason for patient’s attendance: the nature and history of the problem; patient’s ICE • To consider other problems: continuing problems • With the patient choose an appropriate action for each problem • To achieve a shared understanding of the problem with the patient. • To involve the patient in the management and encourage him to accept appropriate responsibility. • To use time and resources appropriately: in consultation and long term • To establish or maintain a relationship with the patient which helps to achieve the other tasks.

  17. Helman’s “Folk Model” • Helman developed a simple model to emphasise the patient’s perspective even further. The ordinary questions which a non medical person would want to know include: • What has happened? • Why has it happened? • Why to me? • Why now? • What would happen if nothing was done about it? • What should I do about it or whom should I consult for further help?

  18. Neighbour’s “The Inner Consultation” • Neighbour describes the consultation as a journey with five checkpoints. • Connecting: getting on the same wavelength as patient. Gaining information about illness • Summarising: a counselling skill which shows you’ve listened and clarified what the patient has said and have understood the reason for consulting you.

  19. Neighbour’s “The Inner Consultation” • Handing over: giving the patient responsibility in the management plan and making sure he’s happy with the outcome of the consultation. • Safety netting: planning for the unexpected. Helps to deal with uncertainty • If I am right what I expect to happen? • How will I know if I am wrong? • What would I do then? • Housekeeping: being aware of your own emotions, how they have influenced this consultation and how they may influence subsequent ones.

  20. Good luck

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