Stakeholder attitudes and perceptions of the new simulated consultation assessment for GP licencing in the United Kingdom: a cross-sectional mixed methods survey

Abstract

Background: The Simulated Consultation Assessment (SCA) replaced the Recorded Consultation Assessment (RCA) as the summative clinical component of the Membership of the Royal College of General Practitioners (MRCGP) examination for the United Kingdom (UK) general practice licencing assessment in 2023. The SCA consists of 12 online consultations with trained role players, with candidates based in their own surgery. This study aimed to gather views of stakeholders on the new assessment before its introduction.

Methods: We conducted a cross-sectional online survey. Stakeholders completing the survey included pre-RCA and post-RCA GP trainees and educator/lay stakeholders. The survey questionnaire included Likert scaled responses and free text options. Analysis included descriptive statistics, scale development measuring positivity towards SCA, a multivariable model showing factors related to this, and qualitative assessment of free text responses.

Results: There were 3,174 responses from 1,533 pre-RCA trainees, 920 post-RCA trainees, and 721 educator/lay stakeholders. Responders overall were positive about the design of SCA in terms of setting, validity, preparation and fairness. Multivariable analysis showed that International Medical Graduates (IMGs) were significantly more positive compared to UK graduates (B 0.19, 95% confidence interval 0.12-0.25, p < 0.001) with no other differences by stakeholder group, age or ethnicity. Qualitative analysis identified four themes relating to setting requirements and contingency planning, acceptability and fairness to candidates, ability to assess consultation skills and the need for evidence for the new assessment.

Conclusion: Stakeholders, while positive overall, expressed suggestions relating to practice setting, the assessment's acceptability and fairness, its ability to assess consultation skills and the need for further evaluation.

Keywords: GP licencing assessments; GP trainee; clinical examinations; consultation skills; fairness; simulated consultation assessment; stakeholders; validity.