Foreword T HE examination for membership of the Royal College of General Practitioners is 25 years old this year and on its silver anniversary it is appropriate to take stock in order to review its development, record its success, and express our thanks to those who made it possible. The early years
It is easy today with a well established examination and up to 2000 candidates a year to forget the history of how it was introduced and what a struggle it represented for those in the College who were farsighted enough to see its importance. It is strange to recall that 25 years ago people doubted that it was possible to examine in general practice, partly because it was assumed to be simply a matter of 'bedside manner' and partly because there was still a belief that general practice was no more than the practice of other specialties in a different setting and at a more superficial level. The determination of the College to devise and implement the first examination of its kind in Europe was all the more important precisely because such a step did demand the definition of the discipline and its subdivision into different categories. It is no accident that the early years of the examination, namely the late 1960s, were the same years in which the College working party produced its so-called Fourth Report, which was published in 1972 as The Future General Practitioner-Learning and Teaching. This was the first book from College authors to provide a framework for the content of general practice as an academic discipline and which set the content in terms of educational objectives. In addition, the institution of a membership examination represented a conscious step towards bringing general practice into the family of medical disciplines and adopting the standard-setting custom long practised by all the older medical Royal Colleges.
Importance of the examination
The significance of the examination for candidates is, as with all examinations, that it provides a framework for preparation for practice and encourages systematic reading, study and discussion. Assessment is indeed, in the words of the Merrison Committee (1975), "an integral part of the educational process" and it is a well known aspect of human nature that the challenge of an examination may be the stimulus for preparation. The importance of the examination in terms of the development of general practice is that it was one of the most powerful catalysts of the new College, still in its first 15 years. It brought together a band of activists, it acted as a powerful stimulus for thought and discussion, it defined and outlined some of the weakest aspects of general practice, and above all it brought rigour and critical intellectual analysis to the subject. Furthermore, it provided a direct stimulus from books about general practice and an indirect stimulus to many general practitioners to write about their subject. The arrival of the examination in 1965 predated the recommendations of the General Medical Council in 1967 which, in a landmark document, closed the door on the MB and MRCS LRCP as end-point examinations guaranteeing clinical competence and changed them instead to being entry tickets to higher professional training. The existence of the examination, albeit in its then rudimentary form, gave encouragement to the College educationalists who, at the same time, were preparing the historically important evidence of the College to the Royal Commission on Medical Education. It was this document, Report from General Practice 5, which led finally to official acceptance of general practice as a major discipline in medicine in the Royal Commission's report in April 1968. Membership of the Royal College of General Practitioners has been accepted for many years by the General Medical Council as an additional registrable qualification, a decision which was undoubtedly influenced by the existence and development of the examination. The examination was thus a product of its time. It was a part, and a particularly important part, of one of the most educationally creative periods in the history of the College. Three themes
Three themes stand out from the three decades in which the examination has been held. First, were the constant striving by those concerned to achieve objectivity and their readiness to use academic and statistical techniques to achieve this. Exercising an objective and judicial function has always v
been harder for the generalist than for the specialist in medicine, and the effect of the examination has been to provide experience to a new generation of general practitioners in judging fellow practitioners. Much of the credit for this development lies with Professor J H Walker, who was for many years the Honorary Examination Secretary of the College and who also held a Chair of Family and Community Medicine at the University of Newcastle upon Tyne. In this way, the examination provided a bridge between the growing College and the emerging university departments of general practice, which did much to foster good communication. Similarly, strong links with vocational training were forged, as many course organizers themselves became examiners and put into practice techniques of critical thought. Secondly, this was always a national examination attracting a steadily growing number of candidates from all over the UK. In recent years written papers have been taken in a number of centres in different parts of the United Kingdom, preparation courses are held and candidates come from all parts of the British Isles. Thirdly, and strikingly in the following pages, the MRCGP examination is a living, dynamic institution ready to review itself, ready to respond to the policies of the College as a whole, and ready to incorporate new ideas and new techniques in the light of evolving practice. For example, the modified essay question, now widely used by other institutions in other subjects, was a special feature of the examination in its early years, and the new critical reading question paper, described in this Occasional Paper, represents an exciting new development which will help to ensure that new members of the College possess the important skill of being able to read a scientific article and accurately assess its content and significance for medical practice.
Acknowledgement The handling of such a large number of candidates and the need to examine them in writing, through orals, and by other means has meant a substantial commitment of time on the part of both the examiners and those running the examination. The College is most grateful to all who have examined on its behalf during the past 25 years and especially to those who have held particular responsibility for initiating and developing its various sections. The College is also grateful to the partners of the examiners, who have released them to undertake their time-consuming and important task. Conclusion It is never easy for a single institution to review objectively its own function but the Royal College of General Practitioners can take much comfort from a recent editorial in the Lancet (1990) which commented on all the examinations of the medical Royal Colleges in the United Kingdom and their methods of operation. Clearly there is much to be learnt, and whilst further improvements will always take place, this at times critical editorial did much to emphasize the objectivity and especially the openness of those responsible for the general practitioners' examination. The Council is confident that these two attributes, objectivity and openness, which have always been part of the general practitioner tradition, will remain the two legs on which assessment in general practice will always stand, and looks forward to further developments and progress in the MRCGP examination in the next 25 years.
DENIS PEREIRA GRAY Chairman of Council 1987-1990 References College of General Practitioners (1966) Evidence of the College of General Practitioners to the Royal Commission on Medical Education. Report from General Practice 5. London, Journal of the Royal College of General Practitioners. General Medical Council (1967) Recommendations as to Basic Medical Education. London, GMC. Lancet (1990) Examining the Royal Colleges' examiners. Editorial, 335, 443-5. Merrison Committee (1975) Report of the Committee of Inquiry into the Regulations of the Medical Profession. Cmnd 6018. London, HMSO. Royal College of General Practitioners (1972) The Future General Practitioner-Learning and Teaching. London, British Medical Journal. Royal Commission on Medical Education (1968) Todd Report. London, HMSO.
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It is easy today with a well established examination and up to 2000 candidates a year to forget the history of how it was introduced and what a struggle it represented for those in the College who were farsighted enough to see its importance. It is strange to recall that 25 years ago people doubted that it was possible to examine in general practice, partly because it was assumed to be simply a matter of 'bedside manner' and partly because there was still a belief that general practice was no more than the practice of other specialties in a different setting and at a more superficial level. The determination of the College to devise and implement the first examination of its kind in Europe was all the more important precisely because such a step did demand the definition of the discipline and its subdivision into different categories. It is no accident that the early years of the examination, namely the late 1960s, were the same years in which the College working party produced its so-called Fourth Report, which was published in 1972 as The Future General Practitioner-Learning and Teaching. This was the first book from College authors to provide a framework for the content of general practice as an academic discipline and which set the content in terms of educational objectives. In addition, the institution of a membership examination represented a conscious step towards bringing general practice into the family of medical disciplines and adopting the standard-setting custom long practised by all the older medical Royal Colleges.
Importance of the examination
The significance of the examination for candidates is, as with all examinations, that it provides a framework for preparation for practice and encourages systematic reading, study and discussion. Assessment is indeed, in the words of the Merrison Committee (1975), "an integral part of the educational process" and it is a well known aspect of human nature that the challenge of an examination may be the stimulus for preparation. The importance of the examination in terms of the development of general practice is that it was one of the most powerful catalysts of the new College, still in its first 15 years. It brought together a band of activists, it acted as a powerful stimulus for thought and discussion, it defined and outlined some of the weakest aspects of general practice, and above all it brought rigour and critical intellectual analysis to the subject. Furthermore, it provided a direct stimulus from books about general practice and an indirect stimulus to many general practitioners to write about their subject. The arrival of the examination in 1965 predated the recommendations of the General Medical Council in 1967 which, in a landmark document, closed the door on the MB and MRCS LRCP as end-point examinations guaranteeing clinical competence and changed them instead to being entry tickets to higher professional training. The existence of the examination, albeit in its then rudimentary form, gave encouragement to the College educationalists who, at the same time, were preparing the historically important evidence of the College to the Royal Commission on Medical Education. It was this document, Report from General Practice 5, which led finally to official acceptance of general practice as a major discipline in medicine in the Royal Commission's report in April 1968. Membership of the Royal College of General Practitioners has been accepted for many years by the General Medical Council as an additional registrable qualification, a decision which was undoubtedly influenced by the existence and development of the examination. The examination was thus a product of its time. It was a part, and a particularly important part, of one of the most educationally creative periods in the history of the College. Three themes
Three themes stand out from the three decades in which the examination has been held. First, were the constant striving by those concerned to achieve objectivity and their readiness to use academic and statistical techniques to achieve this. Exercising an objective and judicial function has always v
been harder for the generalist than for the specialist in medicine, and the effect of the examination has been to provide experience to a new generation of general practitioners in judging fellow practitioners. Much of the credit for this development lies with Professor J H Walker, who was for many years the Honorary Examination Secretary of the College and who also held a Chair of Family and Community Medicine at the University of Newcastle upon Tyne. In this way, the examination provided a bridge between the growing College and the emerging university departments of general practice, which did much to foster good communication. Similarly, strong links with vocational training were forged, as many course organizers themselves became examiners and put into practice techniques of critical thought. Secondly, this was always a national examination attracting a steadily growing number of candidates from all over the UK. In recent years written papers have been taken in a number of centres in different parts of the United Kingdom, preparation courses are held and candidates come from all parts of the British Isles. Thirdly, and strikingly in the following pages, the MRCGP examination is a living, dynamic institution ready to review itself, ready to respond to the policies of the College as a whole, and ready to incorporate new ideas and new techniques in the light of evolving practice. For example, the modified essay question, now widely used by other institutions in other subjects, was a special feature of the examination in its early years, and the new critical reading question paper, described in this Occasional Paper, represents an exciting new development which will help to ensure that new members of the College possess the important skill of being able to read a scientific article and accurately assess its content and significance for medical practice.
Acknowledgement The handling of such a large number of candidates and the need to examine them in writing, through orals, and by other means has meant a substantial commitment of time on the part of both the examiners and those running the examination. The College is most grateful to all who have examined on its behalf during the past 25 years and especially to those who have held particular responsibility for initiating and developing its various sections. The College is also grateful to the partners of the examiners, who have released them to undertake their time-consuming and important task. Conclusion It is never easy for a single institution to review objectively its own function but the Royal College of General Practitioners can take much comfort from a recent editorial in the Lancet (1990) which commented on all the examinations of the medical Royal Colleges in the United Kingdom and their methods of operation. Clearly there is much to be learnt, and whilst further improvements will always take place, this at times critical editorial did much to emphasize the objectivity and especially the openness of those responsible for the general practitioners' examination. The Council is confident that these two attributes, objectivity and openness, which have always been part of the general practitioner tradition, will remain the two legs on which assessment in general practice will always stand, and looks forward to further developments and progress in the MRCGP examination in the next 25 years.
DENIS PEREIRA GRAY Chairman of Council 1987-1990 References College of General Practitioners (1966) Evidence of the College of General Practitioners to the Royal Commission on Medical Education. Report from General Practice 5. London, Journal of the Royal College of General Practitioners. General Medical Council (1967) Recommendations as to Basic Medical Education. London, GMC. Lancet (1990) Examining the Royal Colleges' examiners. Editorial, 335, 443-5. Merrison Committee (1975) Report of the Committee of Inquiry into the Regulations of the Medical Profession. Cmnd 6018. London, HMSO. Royal College of General Practitioners (1972) The Future General Practitioner-Learning and Teaching. London, British Medical Journal. Royal Commission on Medical Education (1968) Todd Report. London, HMSO.
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