title: Formative assessment of GP trainees' clinical skills.
abstract: BACKGROUND
  Clinical skill assessment (CSA) has been an integral part of the Royal College of General Practitioners' membership examination (MRCGP) since 2008. It is an expensive, high-stakes examination with first time pass rates ranging from 76.4 to 81.3. In this paper we describe  the South East Scotland Deanery, NHS Education Scotland, pilot of a formative clinical skills assessment (fCSA) using the principles of formative assessment and OSCE.  The purpose of the study was to assess the acceptability of the fCSA and to examine whether trainees, identified during  the fCSA as 'at risk of failing the MRCGP CSA exam', are more likely to fail the MRCGP CSA exam later on in the year.
  
  
  METHODS
  Trainees were assessed in four clinical skills stations under exam conditions. After each station they were given verbal feedback and subsequently both trainee  and their trainer received written feedback.  We assessed the value of the exercise through written feedback from trainees and trainers.  Each trainee's performance in fCSA was triangulated with trainer assessment to identify 'flagged trainees'. We compared flagged and non-flagged trainees'  performance in MRCGP CSA.
  
  
  RESULTS
  Both trainees and trainers highly rated the fCSA. Overall 97% of non-flagged trainees have passed the RCGP CSA exam by May of that year in comparison to 80% of flagged trainees who have passed the RCGP CSA (P = 0.005). Trainers and trainees  rated the fCSA as excellent and useful.
  
  
  CONCLUSIONS
  We were able to demonstrate that the fCSA can be used to identify those trainees likely to fail the RCGP CSA. Contrary to reservations about the potential to demoralise trainees, the fCSA was viewed as a useful and a positive experience  by both trainees and trainers. In addition, we suggest that feedback from fCSA was useful in triggering appropriate educational interventions.  Early intervention with trainees who are predicted to fail the CSA has the potential to reduce deaneries overall fail rate. Preventing one trainee  failure could save over £30 000.
authors.affiliation: The Lister, Edinburgh EH8 9DR, UK. Sharon.Wiener-Ogilvie@nes.scot.nhs.uk
authors.forename: Sharon
authors.initials: S
authors.lastname: Wiener-Ogilvie
authors.forename: Drummond
authors.initials: D
authors.lastname: Begg
mesh_terms: D002983:Clinical Competence; D004521:Educational Measurement / Q000379:methods*; D058006:General Practice / Q000193:education*; D006801:Humans; D007396:Internship and Residency / Q000379:methods*