Succeeding in the GP specialty training stage 3 selection centre
Authors: Matt Green
Publication date: 20 Oct 2011
Matt Green of the BPP University College School of Health explores how to prepare for GPST stage 3 selection
The aim of the general practitioner specialty training (GPST) stage 3 selection centre is to determine whether you meet the various competencies that accurately and fairly identify candidates who are suitable for a career in general practice. Guidance on what the GPST stage 3 selection centre entails, examples of tasks, and what documentation to bring (such as structured reference forms, medical qualifications, and identification) are listed at www.gprecruitment.org.uk.
Understanding the national person specification
The key to success in the GPST stage 3 selection centre is to have a good understanding of what the national person specification comprises, as this is what you will be assessed against. An understanding of the components of the national person specification, together with how each component relates to the tasks, will stand you in good stead.
Clinical knowledge and skills—Your ability to diagnose clinical problems and a demonstration of the options open to you to reach your diagnosis safely and within your limits.
Empathy and sensitivity—Your ability to view a given situation from another person’s point of view, including patients, family, and colleagues, and to treat them with respect and compassion.
Communication skills—Your ability to demonstrate clear and appropriate communication, including effective listening skills, and your ability to adapt and alter your method of communication to suit a given situation.
Conceptual thinking and problem solving—Your ability to think outside the box and view a given problem laterally to apply your knowledge and reach a solution.
Coping with pressure—Your strategies to cope with pressure, your self awareness of your own limits, and your willingness to seek help from others.
Organisation and planning—Your ability to manage your own time and resources and those of others effectively.
Managing others and team involvement—Your ability to work effectively as part of a multidisciplinary team.
Professional integrity—Your ability to take responsibility for your behaviour and actions and to treat all those you encounter with respect and compassion.
Commitment to specialty
Learning and personal development—Your ability to show a passion for general practice together with the ability to reflect on your experiences, learn from them, and identify new opportunities to maintain and broaden your skills and knowledge.
Selection tasks you will encounter
A recent change to GPST stage 3 selection means that the group discussion task is no longer included as part of the assessment; instead the simulation exercise will be increased to three different 10 minute exercises. You will also have to do a written prioritisation task. It is important to note that the assessors on the day will have no access to your CV or application form and will therefore be scoring you solely on your performance in each task.
Simulation tasks—primary care consultations are different from hospital clerking
It is important to note that the simulation tasks normally do not entail a physical examination and that your clinical expertise is not the primary focus of assessment. The new format of the simulation task means that you will face three 10 minute consultations: one with a patient, one with a relative or carer, and one with a non-medical colleague. The parts of the patient, relative, or colleague are usually played by trained actors. A part may be played by an examiner, although this is not common. You will also have one or two trained examiners with you in the room, who are usually doctors such as GPs or consultants specifically trained for this purpose but can also be trained educational psychologists. The examiners will make sure that you understand the instructions but will remain silent throughout the exercise and will not be involved in the role play.
The “patients” have been given a defined part to play, which will usually bring out specific issues. They are given instructions not only on what to say but also on their appearance and demeanour. They are also occasionally told to withhold certain information unless you ask them the correct question or make them feel comfortable enough to tell you. These simulators will also assess your performance, commenting especially on how you made them feel during the exercise—for example, whether you made them feel comfortable and whether they believed that you were generally concerned and had shown a genuine interest in what they had to say. These comments may sometimes, but not always, be used in the assessment of your competencies.
Some common cases you may encounter are:
Having to explain a condition (usually chronic) to a patient
Breaking bad news
Dealing with an error or a mistake made by yourself or another doctor
Dealing with a complaint
Dealing with a difficult, angry, or demanding patient
Explaining a test result or procedure
Dealing with a patient who complies poorly with treatment, such as not using an inhaler appropriately
Dealing with psychosocial issues.
There are distinct differences between the way GPs and hospital doctors consult. You need to learn how to ask patients the right questions, trying to understand the reasons behind their presentation and uncovering the issues and beliefs that lie behind their physical symptoms. It is also important in general practice to involve the patient in management decisions, as opposed to dictating to the patient what you think is best. This is known as patient centred consultation.
You should be aware of several key points and incorporate them into your approach to your consultation:
Safety netting—Unlike hospital based medicine, general practice often entails making diagnoses and management plans with little access to immediate investigations such as blood tests or x ray films. Thus it is important to ensure that you “safety net.”
Ideas, concerns, and expectations—The concept of the patient centred consultation entails treating the patient as a whole and taking into account their beliefs, thoughts, and feelings during the consultation.
Hidden agenda—The hidden agenda is essentially the real reason the patient is coming to see you that may not be the patient’s “presenting complaint,” and you have to use your communication skills, firstly to work out whether there is a hidden agenda and secondly to try to identify what the agenda is.
Active listening—This is a more structured approach to listening, where you not only use silence but also try to understand what the speaker is really saying and how he or she is feeling. This may entail picking up on verbal and non-verbal clues while the other person is talking but also “reflecting back” what the person has said, to show understanding.
Open ended questions—How you phrase a question will determine the quantity and the quality of the information you receive and is important when asking patients their reason for coming to see you.
Written task—justification is key to prioritisation
For the written exercise you will usually be given five minutes to read the task description and roughly 20 minutes to complete it. The exercise description will consist of:
A paragraph describing the setting and what your role is
A list of five or six tasks that need to be completed, and
A set of clear instructions asking you to rank the tasks, justify why you have ranked them in that order, and discuss the related issues around each of them.
You may also be asked to reflect on one aspect of the task—to consider what you have done and discuss points concerning this.
The written task is by far the most time pressured of the assessments you will face and has been deliberately designed as such. There is no “right” answer, but what is sought is an approach that is well reasoned and justified. There are many ways in which you could tackle a particular scenario, but it is imperative that you justify your answers. You must explain why you have ranked the tasks in a particular order and provide clear reasons. Different people will have different priorities, but this does not necessarily mean that one is better than the other or that one is right and the other is wrong. If it is clear that you have thought your answer through systematically, logically, and in accordance with the General Medical Council’s Good Medical Practice guidelines and the national person specification, it is likely that you will tick the right boxes.
A clear understanding of the basics of effective consultation skills in the primary care setting will help you to stand head and shoulders above your fellow applicants.
Familiarise yourself with the national person specification so that when you are faced with a task you will be aware of what you are being assessed on.
Practise, practise, practise role plays and prioritisation tasks with your colleagues to ensure that you are fully prepared for the day.
Follow the instructions provided on the day to avoid loss of easy marks.
Competing interests: Matt Green is the editor of Succeeding in the GPST Stage 2 and Succeeding in the GPST Stage 3, published by BPP Learning Media.
Matt Green medical publishing director
BPP Learning Media, London, UK