The UK medical regulator, the General Medical Council (GMC), sets out standards that our examinations must meet in the GMC Standards for curricula and assessment systems. The GMC holds the Federation of the Royal Colleges of Physicians accountable for these standards in accordance with the Medical Act 1983, and approves our examinations as part of approved UK training programmes.
More about the work MRCP(UK) does to meet each of the GMC standards relevant to our exams:
The assessment system must be fit for purpose
Standard 2: The overall purpose of the assessment system must be documented and in the public domain.
Our regulations and information for candidates specify the functions of each and all components of our examinations. These are available on our website to trainees, educators, employers, professional bodies including the regulatory bodies, and the public.
The sequence of our assessments matches the progression of trainees through the approved curriculum and individual assessments are designed to add unique information and build on previous assessments:
For internal medicine training (IMT) / core medical training (CMT): MRCP(UK) Part 1 and Part 2 written examinations and Part 2 clinical examination (PACES) are required for progression into higher specialty training so must be completed during IMT/CMT. Part 1 has to be successfully completed before candidates are eligible to take the Part 2 written examination or Part 2 clinical examination (PACES).
The MRCP(UK) Part 1 written examination tests a broad knowledge and understanding of common and important disorders as well as clinical science; the Part 2 written examination tests the ability to apply this knowledge to clinical problem solving and clinical practice; and the Part 2 clinical examination (PACES) tests clinical knowledge and skills, including practical examination and communication skills.
For specialty curricula: The Specialty Certificate Examinations (SCEs) are run in 12 specialities and are specifically designed to test specialist knowledge as trainees reach the end of their training programme.
The SCEs assess knowledge and understanding of the clinical sciences relevant to specialist medical practice and of common or important disorders to a level appropriate for a newly appointed consultant. They also provide a professional standard against which physicians working outside the UK can measure their level of attainment.
Assessment system methods
Standard 8: The choice of assessment method(s) should be appropriate to the content and purpose of that element of the curriculum.
We consider the evidence base when choosing an assessment method and take account of validity, reliability, feasibility, cost effectiveness, opportunities for feedback, and impact on learning.
To test knowledge and application of knowledge in our written examinations we use ‘best of five’ multiple choice questions. The number of questions and length of the examination ensures reliability and the clinical scenarios improve the validity of the questions.
To test clinical and practical skills we use a clinical examination, with real and simulated patients.
We collect data about performance in all our examinations and publish pass rates on our website.
Assessment feedback to the trainees
Standard 11: Assessments must provide relevant feedback to the trainees.
We provide feedback to candidates following all of our examinations. For the written examinations the results letter sets out the examination result (pass or fail); the overall score (the mark the candidate achieved in the examination); the pass mark (the mark required to pass the examination); and a detailed analysis of performance structured against the blueprint headings (percentage of questions answered correctly in each topic area).
For the Part 2 clinical examination (PACES) we provide a detailed breakdown of marks, the pass mark, and examination result for each skill and each encounter as well as an overall examination result (pass or fail). Some candidates will be identified as requiring extra feedback (’counselling’), either from their College of entry or the Clinical Examining Board. Counselling will normally take the form of written feedback but, occasionally, a meeting with a nominated individual may be arranged.
Documentation will be standardised and accessible nationally
Standard 13: Documentation will record the results and consequences of assessments and the trainee’s progress through the assessment system.
The results letters and certificates we issue are standardised and information on UK trainee examination performance is shared with the Joint Royal Colleges of Physicians Training Board (JRCPTB) so it is accessible by trainees and their supervisors from the e-portfolio.
We publish collated information on pass rates to enable appropriate access. We have a data protection statement available on our website and application forms.
Lay and patient involvement
Standard 16: There will be lay and patient input in the development and implementation of assessments.
Lay and patient representation is essential to provide a different perspective; have an independent overview; promote the viewpoint of the general public and patients; and provide additional independent input to quality managing delivery of examinations.
We have lay representation on MRCP(UK) Management Board, the Clinical Examining Board and Scenario Editorial Committee, MRCP(UK) Standards Annual Review Group and the SCE Steering Group. Real patients and simulated patients are used in the delivery of PACES.
Content of the assessment
Standard 4: Assessments must systematically sample the entire content, appropriate to the stage of training, with reference to the common and important clinical problems that the trainee will encounter in the workplace and to the wider base of knowledge, skills and attitudes demonstrated through behaviours that doctors require.
Our Part 1 and Part 2 written examinations and Part 2 clinical examination (PACES) sample the content of the core medical training and level one General Internal Medicine (GIM) curricula. Within the curricula the syllabus content tables set out ‘Assessment Methods’ and our exams could assess each competency where Part 1, Part 2 or PACES is shown. For GIM our examinations cover aspects of the system specific competencies.
Questions in our SCEs sample the content of the relevant specialty curriculum. Within the curriculum the syllabus content tables set out ‘Assessment Methods’ and the SCE could assess knowledge where SCE is shown alongside each competency.
For each written examination there is a blueprint that indicates the likely number of questions in each topic area. We also use the blueprint to structure feedback to candidates when results are issued. These are available on our website to trainees and trainers in addition to assessors/examiners. Please see the relevant page about the Part 1 or Part 2 written examination or SCE for more information.
For the Part 2 clinical examination (PACES) there are five stations: two test physical examination skills, and the other three test history-taking skills, communication skills and ethics, and integrated clinical assessment using history taking, examination and communication.
Role of the assessor
Standard 10: Assessors/examiners will be recruited against criteria for performing the tasks they undertake.
We have a clear recruitment and appointment process for all those wishing to be involved in our examinations. Each role has defined responsibilities, which are documented and available on our website.
Guidance, induction and training are provided to new examiners specific to their role. Performance is monitored, a census takes place annually to check examiners continue to meet our criteria, and appraisals take place.
Specialist expertise is used appropriately to ensure examiners only assess in areas where they have competence and the relevant professional experience of assessors is greater than that of candidates being assessed.
We have eligibility criteria for all examiner roles, which includes completion of equality and diversity training.
Standards for classification of trainees’ performance/competence
Standard 12: The methods used to set standards for classification of trainees’ performance/competence must be transparent and in the public domain.
We use recognised methods to set the standards of our examinations.
For MRCP(UK) Part 1 and Part 2 written examinations we use equating, a statistical process based on Item Response Theory, to ensure that candidates receive comparable results for comparable performance in different diets of the examination. The MRCP(UK) Part 1 and Part 2 Standard Setting Groups determine the pass mark in advance, and the pass rate may vary from one diet to another.
To pass the MRCP(UK) Clinical Examination (PACES), candidates will be required to attain a minimum standard in each of the seven skills assessed and also attain a minimum total score across the whole assessment. The MRCP(UK) Clinical Examining Board (CEB) sets the pass marks on an annual basis before the examination. The pass rate may vary from one diet to another.
For the SCEs we use the modified Angoff method and judgements made by standard setters are collated into a criterion-referenced pass mark. This pass mark is combined with the performance of UK trainees using the Hofstee compromise method to establish the final pass mark. As a result of the standard setting process, the pass mark and pass rate may vary at each SCE.
We have an appeals process in place and available on our website for candidates.
Resources
Standard 15: Resources and infrastructure will be available to support trainee learning and assessment at all levels (national, deanery and local education provider).
Guidance, induction and training are provided to new examiners targeted to their role (for example: question writing, exam board, standard setting, and clinical examining).
We provide a range of resources on our website to help candidates prepare for the examinations. Please see the relevant examination page for more details.
Equality and diversity
Standard 17: The curriculum should state its compliance with equal opportunities and anti-discriminatory practice.
We routinely analyse and monitor our exam results and pass rates by ethnicity and gender, UK and international graduates, UK and non-UK trainee and stage of training when sitting the exam.
We have policies in place for candidates to request reasonable adjustments due to a disability or special requirement and we monitor the outcome of requests.
We have undertaken research in a number of areas, including investigating possible ethnicity and sex bias in clinical examiners. Please see our research page for more information.
The other GMC standards relate primarily to the curricula on which our exams are based and its implementation:
Curriculum purpose and development
Standard 1: The purpose of the curriculum must be stated, including linkages to previous and subsequent stages of the trainees’ training and education.
The appropriateness of the stated curriculum to the stage of learning and to the specialty in question must be described.
The JRCPTB is responsible for producing the curricula, and each curriculum defines the process of training and the competencies required as well as how the curriculum was developed.
For our examinations the relevant curriculum can be found at:
Core medical training (for MRCP(UK) Part 1 and Part 2 written examinations and PACES)
Specialty curricula (for the Specialty Certificate Examinations)
Managing curriculum implementation
Standard 5: Indication should be given of how curriculum implementation will be managed and assured locally and within approved programmes.
The JRCPTB is responsible for producing the UK medical specialty curricula and work with the local training committee and regional specialty adviser to support curriculum implementation for trainees and trainers.
Postgraduate deaneries or their equivalent are responsible for quality management; the GMC is responsible for quality assurance and local educational providers are responsible for quality control. The role of the Colleges in quality management remains important and will be delivered in partnership with the deaneries and/or the GMC.
Model of learning and learning experiences
Standard 6: The curriculum must describe the model of learning appropriate to the specialty and stage of training.
Standard 7: Recommended learning experiences must be described which allow a diversity of methods covering, at a minimum:
- learning from practice
- opportunities for concentrated practice in skills and procedures
- learning with peers
- learning in formal situations inside and outside the department
- personal study
- specific trainer/supervisor inputs.
The JRCPTB is responsible for producing the UK medical specialty curricula, which specify the models of learning. Training will be delivered through a variety of learning experiences, ranging from formal teaching programmes to experiential learning ‘on the job’ and self-directed learning. The proportion of time allocated to different learning methods may vary depending on the nature of the attachment within a rotation.
Curriculum review and updating
Standard 14: Plans for curriculum review, including curriculum evaluation and monitoring, must be set out.
The JRCPTB is responsible for ensuring that the UK medical specialty curricula remain up to date. Annual reviews take place for minor changes and each curriculum will be subject to three-yearly formal review informed by curriculum evaluation and monitoring. Each curriculum aims to respond quickly to new clinical and service developments. Trainees, patients and lay persons are involved in curricula review.
Content of the curriculum
Standard 3: The curriculum must set out the general, professional, and specialty-specific content to be mastered, including:
- the acquisition of knowledge, skills, and attitudes demonstrated through behaviours, and expertise
- the recommendations on the sequencing of learning and experience should be provided, if appropriate
- the general professional content should include a statement about how Good Medical Practice is to be addressed.
The JRCPTB is responsible for producing the UK medical specialty curricula, which set out the general, professional, and specialty-specific content for each medical specialty. For our examinations the relevant curriculum can be found at:
Core medical training (for MRCP(UK) Part 1 and Part 2 written examinations and PACES)
Specialty curricula (for the Specialty Certificate Examinations)
Supervision of the trainee
Standard 9: Mechanisms for supervision of the trainee should be set out.
The JRCPTB is responsible for producing the UK medical specialty curricula, which specify the supervision requirements for learning.
All elements of work in training posts must be supervised with the level of supervision varying depending on the experience of the trainee and the clinical exposure and case mix undertaken.
As training progresses the trainee should have the opportunity for increasing autonomy, consistent with safe and effective care for the patient.
Trainees will at all times have a named Educational Supervisor and Clinical Supervisor, responsible for overseeing their education. Training is provided for these roles.
We work closely with the Joint Royal College of Physicians Training Board (JRCPTB), who has primary responsibility for these standards, and whose primary functions are:
- the production of UK specialty curricula, including specified assessment methods, for 29 medical specialties and three subspecialties, as well as for core medical training (CMT);
- providing external advice to UK postgraduate deaneries or equivalent on the quality management of training in different locations as part of the GMC’s Quality Improvement Framework;
- recording and monitoring UK trainees’ progress and making recommendations for the award of specialty certification.