MRCGP & GP Training

CEPS - Clinical Examination & Procedural Skills

What are CEPS?

Clinical Examination and certain clinical procedures are an important element of a GP’s work.  Therefore, trainees wishing to become GPs need to demonstrate they are good at them.    And whilst the trainee is meant to collect a variety of evidence showing that they are good at the different clinical examination of the systems there are 5 that the RCGP have deemed essential – the breast, rectal, prostate and male genital and female genital examinations.  These mandatory examinations were chosen because they are considered sufficiently important and/or technically demanding to warrant specific assessment. 

Breast

Rectal

Prostate

Male Genital

Female Genital

How can I record evidence in terms of CEPS?

Completion of CEPS can occur in a variety of ways and these include;

  1. The CEPS evidence form (in the evidence section of the ePortfolio)
  2. Learning logs (there is a filter for CEPS entries) – write a log entry, something like “Resp examination -“some subcostal recession and intercostal recession note, no use of other accessory muscles, RR=35, SaO2 = 94%, Chest Ex = BS – good A/E but wheeze noted right side and creps at the right base”
  3. Mini-CEX
  4. COT (criterion 6 refers to examination skills)  – keep the video recording even if you cannot see the examination on the video.
  5. MSF – colleagues will have observed you doing examinations and can give an idea of what they think of your technical skills when you ask for feedback from them via the MSF.
  6. CSR – likewise, your Clinical Supervisor will have observed you doing examinations and can give an idea of what he or she thinks of your technical skills when they write up your Clinical Supervisor’s Report.

FAQs

A suitably trained professional will need to observe and document your performance on a CEPS evidence form.

In hospital:

  • Consultants
  • Experienced SpRs
  • Staff grades,
  • Appropriate nursing staff

In GP posts:

  • GP trainer
  • GP partners
  • Salaried GPs
  • Appropriate nurses
WARNING: do NOT use other GP trainees to assess you!  You will be reprimanded if you do!

You will not be able to be signed up as competent in CEPS by your Educational Supervisor during your final review, unless there is observed evidence of the 5 mandatory intimate skills and a range of CEPs relevant to General Practice. This will also be reviewed at your ARCP and an unsatisfactory outcome given if these are not present.  They are the

  1. breast
  2. rectal
  3. prostate
  4. male genital
  5. female genital examinations

There is no agreed definition of what constitutes an intimate examination.  The five examinations for which evidence of competence is required by the GMC are generally accepted examples of intimate examinations but there are many others.  For instance, the competent examination of the eye with an ophthalmoscope is considered by many, if not most, patients to be an intimate examination, especially as it requires the examination room to be darkened.  Ultimately it is the individual patient who determines what is intimate or invasive for them and this will be determined by a number of possible factors including their prior experiences, their religion and their cultural background.

There is no set number. There needs to be enough to demonstrate, to your Educational Supervisor’s satisfaction, your competence in CEPS.  Basically, you keep doing them until you are deemed competent.   Remember: it is your responsibility to ensure that you complete the appropriate assessments and build up a record of your training and evidence of competence through the e-portfolio.

If your Educational Supervisor is satisfied that the evidence you have provided for one of the five intimate examinations as required by the GMC is sufficient this does not need to be repeated.   So, if you have successfully demonstrated competence in an examination is say ST1 or ST2, there is no need to demonstrate it again in ST3.   

However, it is important that this evidence is recorded in such a way that you can remember where it is.  The easiest ways to do this is to use the CEPS forms.  At the final review before a Certificate of Completion of Training (CCT) is recommended your Educational Supervisor will need to answer a specific question in relation to these examinations. 

The standard is that of an independent fully qualified General Practitioner.  As well as the technical aspects of examination and the ability to recognise abnormal physical signs, it includes the choice of examination best suited to the clinical context.  For instance, a competent GP very rarely performs an extensive neurological examination but will perform a limited neurological examination as determined by the history taken from the patient. 

Estimated time required : 10 – 20 minutes (5 – 15 min for assessment, 5 min for feedback).

No!  So – forget going to a simulation centre or equivalent.  All DOPS have to be done on real alive human beings, with their consent.   CEPS are not only about your technical proficiency at doing the examination/procedure but also about the way you handle and treat the patient.   This latter bit cannot be assessed on a dummy!  And we need to make sure you can do the WHOLE thing as a complete package.

Make it easy for others to find your mandatory CEPS evidence in your ePortfolio

For the 5 mandatory CEPS

  • It is really important that Educational Supervisors and the ARCP can easily see your evidence for the mandatory CEPS at your reviews.
  • The best way – for the MANDATORY CEPS – is clearly to use the CEPS forms under “Evidence”
For all other non-mandatory clinical examination and procedures…
  • When you write a log entry that you feel satisfies the CEPS competency, ensure your trainer validates it against the CEPS competency.
  • When asking your colleagues for feedback (MSF), ask them to specifically mention a thing or two about any clinical examinations they have observed.
  • There is a specific section in the COT, MiniCEX and CSR that specifically asks the assessor to write about this.

I am finding it difficult to get the intimate examinations done... What can I do?

First, let’s be clear about one thing:  you have to get these intimate examinations done before you finish your training – it’s a requirement for CCT!   This is not negotiable.  No excuses are deemed acceptable.  We understand that if you are a male trainee, this can be particularly difficult to get done.  Here are some suggestions.

  1. Book patients that you see who need a male or female examination with you and an appropriate supervisor.  Perhaps during a joint ‘sit and swap’ surgery?
  2. If your practice runs a smear clinic or a women’s health clinic – see if you can attend.
  3. Ring your local Gynae Outpatient Department or Colposcopy Clinic or even the GUM clinic  – and ask them if you can attend with a view to getting your intimate examinations done.     
  4. You might even be able to attend the GPwSI (GP with a Special Interest) Clinic for Gynae or Urology.
  5.  Consider contacting the local GUM/STI clinic to see if you can attend to help out and in doing so, get them to observe you doing the intimate examinations.

Got any suggestions or advice?

Got any advice?  Anything we’ve missed?  Then leave a message below.   Got a resource to share: contact [email protected]

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