Selecting general practice specialty trainees: where next?

Selection into GP speciality training is based on results of a multi-method job analysis study. Six key competency domains were identified as priorities to assess through the current national selection process, including empathy, communication, integrity, clinical expertise, problem-solving, and resilience. Each applicant is assessed using clinical problem-solving and situational judgement machine marked tests, followed by high fidelity exercises at regional selection centres. These show good internal reliability and predictive validity, with high correlations with subsequent job performance and outcomes in the MRCGP examinations. Candidate feedback is generally positive, where candidates prefer multiple opportunities to demonstrate their aptitude. When comparing selection methods, candidates perceive high fidelity assessments (for example, a consultation exercise with a simulated patient) as the most job relevant and fair. Emerging data provides opportunities to both streamline and re-engineer the process, so as to optimise efficiency (including cost-effectiveness) while further developing its robustness. Logistic considerations favour delivery of multiple equated versions of machine marked tests in invigilated test centres. As with other assessments in medical education, concerns remain about differential performance between UK and international medical graduates. There is an urgent need to review the job analysis and selection criteria given profound changes in UK general practice taking place over the last decade.