Stakeholders views of the new simulated consultation assessment for GP licensing in the United Kingdom: cross sectional survey

Problem

The new Simulated Consultation Assessment (SCA) has been approved by the General Medical Council for implementation in 2024 to replace the Recorded Consultation Assessment (RCA). The SCA will assess GP trainees’ ability to integrate and apply clinical, professional and communication skills for UK licensing. Taking place online in a local surgery, the SCA will consist of 12 visual or audio consultations with trained role players each lasting 12 minutes. We aimed to gather views on the new assessment from a wide range of stakeholders prior to its introduction.

Approach

A cross-sectional mixed methods survey was developed to elicit stakeholders views on the proposed SCA. GP trainees who had not yet sat the RCA, trainees and newly qualified GPs who had completed the RCA and other stakeholders including educators, examiners, other public and professional groups were invited to complete the survey in 2023. The survey included Likert scaled responses and free text options to questions on the setting, case selection, marking, preparation, and fairness together with responders demographic information. Quantitative analysis included descriptive statistics, scale development measuring positivity towards SCA, and qualitative analysis of free text responses supported by NVivo.

Findings

There were 3174 responses from 1533 pre-RCA trainees, 920 post-RCA trainees or GPs, and 721 other stakeholders of different gender, ethnicity and country of primary medical qualification. Overall, responders were positive to the new assessment, particular 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 differences by stakeholder group, age or ethnicity. Qualitative analysis of free text options were analysed and organised into four identified themes related to 1.Practice requirements and contingency planning: having the assessment in a general practice setting was perceived positively, ideally using a large or regional GP surgery, ensuring contingency planning for any disruption or emergency situations, invigilation to minimise a perceived risk of cheating, and ensuring security and privacy for candidates. 2. Acceptability and fairness to candidates: refers to the need to ensure the assessment is acceptable and fair to candidates from all ethnic, socioeconomic and language backgrounds with constructive feedback. 3. Ability to assess consultation skills: fairly, reliably and validly. 4. Need for further evidence: on the reliability and validity of the assessment is needed.

Consequences

Stakeholders overall were positive to the SCA with views expressed on implementation, fairness, reliability, validity and need for further evaluation. Implementation of the SCA was supported with provision for contingency plans against disruptions, security and privacy measures, fairness for all candidates and realistic costs. Further research is needed to provide evidence to support fairness, reliability and validity of the new assessment.