The RCA at a glance:
FAQs, Myth debunker and quick reference guide
Health warning – this is not an official College guide but has been put together by a group of Severn educators who happen to be examiners
What is the RCA?
The Recorded Consultation Assessment (RCA) is the temporary substitute for the CSA exam whilst the latter is not able to be conducted due to Covid -19 restrictions
This is uncertain but likely to continue until well into 2021. Whether it overlaps with the CSA to accommodate shielding trainees is not yet clear.
But what is it?
It is an assessment of 13 consultations – video, audio or face to face, recorded and submitted by ST3 trainees and assessed by RCA examiners.
So much cheaper than the CSA then?
Unfortunately only a little cheaper as 26 different examiners are needed ( 2 mark each case independently)
Who are the examiners?
CSA examiners (all GPs) who have been trained in assessing the consultations using an online platform.
So, it’s just like the old video assessment for summative assessment?
No, this assessment uses the same domain marking criteria as the CSA, (unlike the ‘old’ video exam which some felt was a ‘tick box ‘exercise)
Three domains of ‘Data Gathering ‘, ‘Clinical Management ‘and ‘Interpersonal Skills ‘, with 3 marks available for each domain (Clear Pass 3 marks, Pass 2 marks, Fail 1 mark ,Clear Fail 0)- see grid below
What’s the pass mark?
Unlike the CSA each case is marked (completely independently) by two different examiners to ensure reliability in what was, at first, a new and untested assessment. Each candidate is assessed by 26 assessors with a total possible mark of 234 (2x117). The mark required to pass varies daily (see below) but will be likely to be between 135 and 145 (a pass in all domains in all cases gets 156)
It sounds much easier than the CSA …
It may sound easier but in fact the standard seems very consistent and so far the percentage passing, using the borderline method which calculates the passing grade needed on each day, is very similar to that of the CSA .
How are the marks awarded if there is no written case to mark against?
Each domain is assessed using a template readily available on the college website (and attached here for easy reference) .The candidates need to demonstrate that they have achieved the expected standard in each domain .In other words if it isn’t seen/ heard in the recording by the end of 10 minutes ,it will be assumed not to have happened.
What is that standard?
The standard required is that of a GP fit for independent practice. Just like the CSA. Each case will be assessed against what is current normal practice for managing whatever presenting complaint is being shown in each case.
Isn’t it much easier since the trainees can choose which consultations to submit, and ‘cherry pick’?
The aim is still the same – to demonstrate good safe consulting fit for independent practice. There is a skill in selecting the correct consultations to submit (see below) but cherry picking may result in selection of low challenge cases that simply do not demonstrate competence.
is it easier to score IP marks on video or F2F rather than telephone?
Analysis so far is that marks are consistent whichever format submitted
What if the patient suddenly brings up a second problem?
Part of the skill of a GP would be to manage this situation. Being able to say something like - that is very interesting, and we do need to deal with that as well. Could we complete todays issue and then we can deal with the second problem at a later date. (or words to that effect)
What are ‘Low challenge cases’?
Below are examples of some consultations that have not presented an opportunity for the candidates to demonstrate their competences:
A previously diagnosed condition, recurred, with the same clinical management as before
Review of meds, no significant change needed
Triage call, needs TCI for exam, management depends on exam findings
The diagnosis & clinical management are reasonably within the scope expected of a non-medically qualified person. i.e. if an HCA would have been able to deal with the same problem as effectively don’t submit!
An ‘expert patient’ who does not allow the doctor to demonstrate competence
How can/should I help as a trainer?
You may well be asked to check every case that your trainee is considering submitting. As they can upload many before making the final submission it is better to help them use the marking grid ( below) to ensure that they can be self-critical of their own consultations and avoid the common pitfalls , possibly using the SoX RAG © rating also attached below – if mostly green , submit, if amber or red reconsider…. (see also the ‘top tips to help trainees’ guide).
Please do NOT suggest whether a case will pass ,but facilitate and guide your trainee to make a critical appraisal of their own consultations and let them decide.
The patient gives most of the DG without being asked and/or tells the doctor the correct diagnosis and management plan ("I googled the management, doctor"). It's very difficult for the candidate to earn marks if they're not having to do some work in the consultation.
Not appearing to be listening to the patient and asking repeated information or inappropriate ICE
Two partial consultations mixed, e.g. one issue DG, another CM
No evidence of a NEW management plan
(e.g. medication reviews with no changes in management
Ignoring serious/major symptoms
Not asking an appropriate range of questions to allow an appropriate differential diagnosis to be reached
Consultations where the only real option is to bring the patient in to be seen F2F with no discussion of possible management plans
When significant element of the consultation happens after 10 min
Advice to trainees from examiners:
• Examiners need to see evidence of focused history taking, making a diagnosis or range of diagnoses, and formulation of a management plan.
• .. need to present new acute undifferentiated cases to demonstrate this eg headache, fatigue, back pain, shoulder pain, sore throat, cough etc, and to actively take a focused history - so 'when did this start?', not 'tell me more'. So, no follow ups, no medication reviews, and no cases where there is no diagnosis to make and the management is straightforward .
• A patient with sciatica who says 'I think I have sciatica, I had it two years ago and I would like some physio as that helped before' is going to be difficult to score well compared with a patient who just says they have back pain.
• Make sure there is “A beginning, a middle and an end.” Remember 1/3 of your marks are for clinical management. Don’t video an overly long clinical history which ends with a plan to bring the patient down to the surgery to examine them ( unless you can set out your intended management plan clearly beforehand)
• Don’t bring back patients you’ve already seen for a review once you’ve read up on their condition. It’s obvious and it doesn’t score highly.
• Do show new problems with some depth. You might perform brilliantly giving antibiotics for otitis externa, but you won’t earn many marks.
• Do watch yourself consulting, learn what you could improve on and adjust your consulting style accordingly.
• Do show the video to your ES before you submit it
Examiners mark only what they see or hear. Better candidates generally demonstrate good history taking while referring to the PMH, psychosocial aspects , medications and previous management plans. They also narrow down a differential diagnosis or identify a list of problems to manage and do it well whilst incorporating the patient’s views.
Another useful tool is the traffic light system used in the SoX programme (with grateful thanks to HEENW and Anne Hawkridge /David Molyneux for permission to share this):