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The RCA

What the examiners like and dislike…

By John Hain
GP Trainer (Yorkshire & the Humber) RCA & CSA examiner.

My dear friend Ramesh asked if an examiner would contribute to the website something along the lines of what we like and dislike when marking the RCA. Here are my thoughts accordingly, but please take these with a pinch of salt, and purely as the personal comments of one individual, not an official RCGP view, and not even necessarily representative.

One thing I like as an examiner is when the candidate shows competence. It can be very uplifting to witness the quality of consulting, especially from Yorkshire of course. Good data-gathering is seldom thrilling, but sound management and excellent inter-personal skills are a joy to behold. Someone picking up on a cue, and sensitively dealing with it (either head-on or after a brief “parking”) can be really impressive. Likewise, we often see someone genuinely caring, going the extra mile, making the most of their knowledge and skill.

Marks are awarded as per the generic grade descriptors which are available on the RCGP website – and we really do stick with these. (Also available as a printable sheet on the Bradford RCA pages – click here and have a look under the DOWNLOADS section for RCA marking sheet).  It’s great when the clip contains enough demonstration of competence in each domain for us to reward well, and frustrating when a seemingly competent candidate submits a clip which includes insufficient evidence.

Worst bugbears? For me, the thing which causes wailing and gnashing of teeth is anything disingenuous. When questions are asked routinely instead of with genuine interest, or when a candidate isn’t listening, the impression is that the candidate doesn’t care. There are no marks for remembering every question we learnt at medical school: the marks are for effectiveness. On a similar theme, some candidates offer bizarre safety-nets like “I agree this is typical of  a wart, but if you develop signs of gangrene you must contact us again immediately, or if feeling unwell call 999”. The exam rewards the same stuff that helps patients, so if you stick with what is genuinely effective, you’ll do well.

The rules are all in the candidate guide so do have a read about case selection, what to show when examining etc- it’s not too onerous really.

The thing which causes wailing and gnashing of teeth is anything disingenuous or when questions are asked routinely instead of with genuine interest, or when a candidate isn’t listening.

One last thing: we all use stock phrases and they can be very useful. Sometimes however, they can be over-used:  “How do you feel about that” is an important question in many situations, but possibly not every 5 minutes? “You have cancer, how do you feel about that”, “I’ll orgainse an X-Ray, how do you feel about that?” “I’ll book you in with my colleague this afternoon, how do you feel about that?”. These curious habits presumably come from over-coaching: I suspect there are expensive courses out there telling trainees “keep asking how pt feels” and “ask everyone if they smoke” and “always give a highly defensive and comprehensive safety net”. All very bad advice I’m afraid.

In summary then- act natural, show you care, and select cases which show you on a good day: demonstrating competence in all three domains within 10 minutes.

Good luck!

John Hain, Harrogate, North Yorkshire.

Some candidates offer bizarre safety-nets like “I agree this is typical of a wart, but if you develop signs of gangrene you must contact us again immediately, or if feeling unwell call 999”.

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