THE MRCGP SIEVE – A structured approach to tackling MRCGP long answer questions to maximise performance, based on the consultation

MRCGP answer plans often involve breaking down the topic in question into a number of issues, each from a different perspective. This allows the candidate to answer the question in a structured way and to consider many different viewpoints.

However candidates often remember a list of different viewpoints such as ‘patient issues’ and ‘doctor issues’ and therefore it can become easy in an exam situation to forget one or more viewpoints from the list. Does a more structured approach exist to help maximise candidate’s performance?

Most questions involve a situation that may be faced by a GP in real life. Taking this approach one can actually address issues as centred around the consultation first, then consider other issues as they move further away from the immediate consultation issues.

The inner circle (the consultation) considers ‘consultation issues’ – i.e. those issues that are relevant to the communication between doctor and patient, such as consultation model, reason for attendance etc. Also present within the inner circle are ‘doctor issues’ such as health, stress, running late, etc and ‘patient issues’ such as financial worries, running late etc.

The next circle (immediate environment) considers the setting in which the doctor and patient operate. To some degree where the issues are placed is arbitrary, and the circle is not exhaustive, but provides a structure for candidates to consider the issues. Listed here are practice and professional issues for doctors, and family and community issues for patients. Educational issues exist for both patient and doctor (although the issues and needs themselves differ) and this provides us with the other educational advantage with the concentric circles sieve – that the situations and issues on ‘the doctor’s side’ are mirrored in the patient’s – i.e. both leave the consultation and interact with their ‘families’ (dr=practice; pt=family) and the ‘community’ the family exists within (dr=profession; pt=community).

The third circle (wider environment) is the issues that are further removed from the immediate situation, but that still influences the other issues, such as secondary care and PCT issues, ethics, society and the media. And further still exists the miscellany of ‘wider issues’.

In an exam the candidate can remember that there are consultation issues (dr, pt, consultation) immediate context issues (practice, profession, family, community, educational), intermediate context issues (PCT/secondary care, ethics, society, media) and wider issues. They can draw the three circles on the front page and have an instant answer plan for almost all the questions. This way the candidate can work out any categories to include in their answer plan even if they forget, as they are using a structure from first principles.

Issues list