Our CCT breakthrough: GP trainees to sit CSA and AKT this summer

A solution has been found for GP trainees, writes committee co-chair Sandesh Gulhane

Location: UK
Published: Thursday 7 May 2020

I am very pleased to be able to write this blog with some good news for GP trainees who have been dealing with uncertainty over the past months about their future and their CCT (certificate of completion of training).

CCT for GP trainees without the CSA (clinical skills assessment) will be based on a recorded assessment alternative to the existing CSA, which means no one will be disadvantaged based on geography. The Royal College of GPs has started to work on how this will be delivered. We have advocated for and delivered exactly what you wanted as a group through the effective work of everybody at the BMA. 

Those trainees who need to pass the AKT (applied knowledge test) will be able to do so via a socially distanced exam and there is work going on to provide an online exam for those shielding.

This will bring security to us at a time when we have worked in unprecedented circumstances to care for our patients and help save lives. Some GP trainees volunteered to go back into ITU and the Nightingale hospitals because they have previous skills as anaesthetists. All senior GP trainees have given up their educational time, meaning they have to complete the e-portfolio requirements stipulated by the RCGP in their own time. We have not seen a surge in exception reports in England. We have taken everything in our stride. This shows the great commitment of GP trainees to our patients and our NHS.  

My co-chair and I have been working closely with stakeholders (the RCGP, GMC, and all the four nation educational bodies), individually and as a group, since the cancellation of exams. (For more detail about our meeting on 24 April, read my last blog post).

We reflected back the triple whammy of the cancellation of exams, loss of educational time and a fundamental shift from face-to-face to telephone/remote consultations, which left GP trainees unable to revise and prepare for the CSA. This is the exam that the vast majority of trainees still need to sit, and there would be an impact on anyone due to CCT in 2020 and perhaps beyond. 

The RCGP presented seven options to address the CCT issue. At this stage, it was hugely important for us to understand how GP trainees would feel about these so I sought the views of a group of GP trainees to understand their preferences. Around 300 trainees completed the survey in 12 hours and we discovered that the top three options were: 

  • No CSA: using video/audio submissions instead of the CSA as a previously validated method
  • No CSA: enhancing the consultation observation tool element of WPBA (workplace-based assessment) instead of the CSA were second
  • No CSA: using the results of other elements of the exam (ie AKT [applied knowledge test] and WPBA) to provide the totality of the MRCGP rather than just a part.

Once it was clear that the RCGP felt there were some options that were most feasible I went back to GP trainees to find out specifically what they felt about these three options. Nearly 500 trainees responded in 12 hours, giving a good spread from around the UK (bar Northern Ireland). The clear ask was to get a video/audio alternative to the CSA.

Criticisms of the current CSA also emerged in the comments, with a theme around a central London exam not being fair to those living across the country – even when the lock down lifts, people were cautious that London would remain the epicentre for the UK, increasing their risk of COVID-19 exposure and the environmental impact of travel was large. Other themes included insufficient time to prepare for exams and the impact of the delays on their mental health. This was all fed back into the discussions which secured the outcome we have achieved.

This is not the end of the road – there are a lot of other considerations that the BMA has discussed and raised on your behalf. We want trainees who have paid for, but not sat, the CSA to get their money back. This is something the RCGP is looking into. At £1,392 it’s a significant amount of money, and we will continue to push for its return.

We have also advocated for this test sitting to be seen as a ‘COVID attempt’, meaning that if you were to fail the exam it would not count toward the total number of attempts you are allowed. This is important: there are currently so many extra pressures on GP trainees that it does not allow for a fair attempt. We also recognise that not all trainees pass and under normal circumstances about 300 require extensions. We have secured automatic extensions for all those who need it.

We have also secured assurances that trainees will get educational time back, so they can prepare properly for their exams. Following comments to our survey, we are also acutely aware of the need to lobby for sufficient preparation time for the CSA, and for a future regional-based exams which negate the need to travel to London.

I appreciate how difficult this time has been for you while you wait to hear about your future. The BMA has been safeguarding and advocating on your behalf; I hope that I have provided some clarity here and that you can start planning for your careers again. 

Sandesh Gulhane is co-chair of the BMA GP trainees committee