Moving on from exam failure


The MRCGP is made up of three components: The Applied Knowledge Test (AKT), a Clinical Skills Assessment (CSA) and Workplace-based Assessments (WPBAs). Each component tests different competencies using validated assessment methods that together cover the spectrum of knowledge, skills, behaviours and attitudes defined by the GP curriculum. The General Medical Council (GMC) has standards on validity, reliability, feasibility, cost effectiveness, opportunities for feedback and impact on learning for each speciality membership exam. The GMC has produced guidance on the number of attempts permissible for membership exams. Currently, GP trainees are offered up to five attempts to pass one of the two components they have failed (either CSA or AKT) as long as they have passed the other.

Failing the AKT

The AKT is a challenging exam with four assessment dates in the 2019–2020 period. For Associates in Training (AiTs) who registered with the College after 1st July 2015, the exam currently costs £450. Following every AKT exam, the RCGP publishes an AKT summary report on its’ website. The pass rate varies statistically at each sitting, depending on multiple variables. In the January 2019 exam, the pass rate was 66.6%. The feedback highlights curriculum areas where trainees did not score as highly, providing specific areas to focus revision on. For trainees who fail the AKT, their GP trainer and Programme Director may suggest a dyslexia assessment if this has not been considered by the trainee before. Trainees with any disabilities or special needs can declare this when booking the exam as they may be eligible for additional time. The RCGP does not recommend any particular books or online revision banks, but in their ‘How to prepare for the AKT’ guide online, RCGP eLearning Essential Knowledge Challenges (EKC) and RCGP Self-Test are recommended. There is also a guide for GP trainers to help their trainee prepare for the exam. The archive of online and current printed issues of InnovAiT contains questions and answers written by the team to help trainees identify their educational needs.

Trainees who have failed the AKT recommend starting revision early and studying on a regular basis. They also mention National Institute for Health and Care Excellence (NICE) guidelines as useful for learning. They advocate practical experience working in general practice as they consider that seeing patients and working in general practice reinforces knowledge.

Failing the CSA

The CSA is an expensive exam to fail, with the current cost for AiTs registered with the College after the 1st July 2015, being £1325. There are usually six assessment dates every year published on the RCGP website. Trainees are assessed in 13 10-minute consultations during a 3-hour exam, with a variety of cases including paediatrics, a home visit and a telephone consultation. Similar to the AKT exam, the RCGP publish CSA summary reports after every exam. In the January/February 2019 exam, the pass rate was 80.4%. Again, each consultation focuses on three domains or areas – data gathering, clinical management and interpersonal skills.

The most important recommendation from trainees failing the CSA exam, is to be part of a peer group and practice cases regularly. Consultation observation tools (COTS), audio-COTs and joint consultations with your GP trainer can be invaluable and demonstrate areas to focus on during consultations. Consulting regularly, both in surgery and in an out-of-hours setting, is essential for CSA preparation. Every patient can be considered as an exam case. Programme Directors are also a good resource, with some schemes offering additional CSA revision sessions in the lead up to exams. The RCGP have a CSA preparation course at the College’s examination centre. This currently costs £375 for members. Each deanery within Health Education England has its’ own CSA resources for trainees. Some areas have courses that all trainees can access, while in other areas, the Programme Directors will highlight to the Associate Dean which trainees may benefit from additional CSA support. It is worth speaking to your Programme Directors to find out what resources are available in your area. The RCGP also has an online e-learning module entitled ‘Clinical Skills Assessment’, focusing on communication and dealing with potentially difficult parts of the consultation. Finally, being familiar with consultation models can help trainees to find a model that suits their style of communication and consulting, in order to demonstrate competence to the examiner in all three domains.

Targeted GP training scheme

The targeted GP training scheme devised by Health Education England is for doctors in current medical practice within the NHS and who left GP training between August 2010 and January 2018. There are GP trainees who have attempted both the CSA and AKT exams and passed only one of these. They may not have had the opportunity of support available to trainees today. They may not have been given sufficient time to achieve the required standards. In recognition of this, the scheme allows such trainees to re-enter GP training for a further 18-month training period.

References and further information

  Health Education England. Targeted GP training Scheme. Available at: (accessed 21 February 2019).
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  RCGP. MRCGP Examinations. Available at: (accessed 20 February 2019).
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Conclusion: Any final tips? Despite being a 3-year training programme, GP trainees are often surprised how quickly this time passes. While the ST2 and ST3 years can be stressful preparing for the AKT and CSA exams, the majority of trainees pass both these exams within their 3-year training period. Trainees who are eligible for additional training time find this extra time changes their perception of the exam in question. They also report greater learning and changing perceptions of the exams following addi
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