Candidate perceptions of the UK Recorded Consultation Assessment: cross-sectional data linkage study

Abstract

The Recorded Consultation Assessment (RCA) was rapidly developed to replace the Clinical Skills Assessment (CSA) for UK general practice licencing during COVID-19. We aimed to evaluate candidate perceptions of the RCA and relationships with performance. We conducted a crosssectional survey of RCA candidates with attitudinal, demographic, and free text response options, undertaking descriptive and factor analysis of quantitative data with qualitative thematic analysis of free text. Binomial regression was used to estimate associations between RCA pass, candidate characteristics and questionnaire responses.645 of 1551 (41.6%) candidates completed a questionnaire; 364 (56.4%) responders permitted linkage with performance and demographic data. Responders and non-responders were similar in exam performance, gender and declared disability but were significantly more likely to be UK graduates (UKG) or white compared with international medical (IMG) or ethnic minority graduates. Responders were positive about the digital platform and support resources. A small overall majority regarded the RCA as a fair assessment; a larger majority reported difficulty collecting, selecting, and submitting cases or felt rushed during recording.Logistic regression showed that ethnicity (white vs minority ethnic: odds ratio [OR] 2.99,95% confidence interval [CI] 1.23, 7.30, p = 0.016), training (UK vs IMG: OR 6.88, 95% CI 2.79, 16.95, p < 0.001), and English as first language (OR 5.11, 0% CI 2.08, 12.56, p < 0.001) were associated with exam success but questionnaire subscales, consultation type submitted, or extent of trainer review were not. The RCA was broadly acceptable but experiences were variable. Candidates experienced challenges and suggested areas for improvement.

Examiner perceptions of the MRCGP recorded consultation assessment for general practice licensing during COVID-19: cross-sectional study

“…In a recent study of candidates' taking the RCA, survey responders were also generally positive about the digital platform despite technical teething problems and were also positive about resources and support provided although contradictory or late guidance, insufficient time to gather cases, and logistic, equipment and cost barriers were noted [11]. A small majority of respondents felt the RCA was a fair assessment of clinical skills, but their experiences of the RCA were less positive, with a larger majority, particularly affecting those in smaller practices with socioeconomic deprivation or language barriers, expressing difficulty accessing and submitting cases and negative impacts on trainees, training, work, and patients described [20]. Candidate felt that the assessment would…”

“…Thirteen consultations were required to align with the CSA which includes 13 face-toface encounters, sometimes including one telephone consultation as an alternative. Each consultation was double marked providing 26 separate evaluations by different examiners for each candidate recording [11]. An initial technical pilot of the new assessment process and information technology platform (phase 1 involving 13 candidates) led to a further (phase 2) pilot with 1551 actual candidates between July and August 2020.…”

“…We sought to evaluate this major change to the assessment by assessing exam performance, psychometrics, and stakeholder experiences of candidates [11] and examiners. This study forms part of this evaluation and aimed to evaluate examiner experiences and perceptions of the phase 2 RCA pilot.…”

Research Paper of the Year 2021: relevant to training and beyond

“…Candidate perceptions of the UK Recorded Consultation Assessment: cross-sectional data linkage study. 6 This study provided early evidence that the Recorded Consultation Assessment (RCA) was a feasible alternative to the Clinical Skills Assessment (CSA) during the COVID-19 pandemic, but also shows areas for improvement. This paper reflects the earliest modifications of the exam, and changes have certainly been made since then to reflect day-to-day practice.…”

Performance of ethnic minority versus White doctors in the MRCGP assessment 2016–2021: a cross-sectional study

“…[7][8][9] Confounding factors implicated in differential attainment by doctors' ethnicity include age, sex and place of primary medical qualification; although these have been included in previous studies of differential attainment, other factors, also related to ethnicity, such as declared disability or performance at selection into GP training have less often been accounted for. [10][11][12] Complex educational and social factors may affect educational progress. 13 The potential contribution of these structural inequalities 14 is recognised in the term 'awarding' rather than 'attainment' gap.…”