Is success in postgraduate examinations associated with family practitioners@ attitudes or patient perceptions of the quality of their consultations? A cross-sectional study of the MRCGP examination in Great Britain

Background. Postgraduate examinations are ubiquitous in medicine worldwide, but studies to validate them are rare. The Royal College of General Practitioners of the UK, over the years in an evolving format, has offered a membership examination (MRCGP) which it believes acts as a quality marker for those who sit it and also positively influences the development of family practice generally. It is not clear, however, if this process identifies quality markers that patients can perceive.

Objectives. To determine if possession of the MRCGP (a doctor defined measure of doctor quality) is associated with the patient enablement score (a patient based consultation outcome measure) and family practitioners' attitudes to the work of family practice.

Methods. Design: survey using the Patient Enablement Instrument (PEI) with linked survey data on family practitioner (FP) demography and possession of the MRCGP, and FPs' attitudes and beliefs using the Cockburn attitudinal questionnaire. Subjects: 15 534 adult patients attending 154 FP principals. Setting: 50 family practices in the UK. Outcome measures: the association between possession of MRCGP, and PEI and Cockburn scores was assessed using regression analysis controlling for known confounders.

Results. There was no association between PEI score and possession of the MRCGP. Only one scale of the Cockburn attitude questionnaire (the belief that patients should be involved in decision making) was positively associated with possessing the MRCGP.

Conclusion. Any advantage in physician quality conferred by passing the MRCGP exam was not detected in this study. Further research into the predictive validity of postgraduate examinations is required preferably using a wider variety of patient and audit based methods.