MRCGP: Exceptional fifth attempts policy and procedure

1. This policy applies to all examination components of the MRCGP that are set and assessed by RCGP:
   • Applied Knowledge Test (AKT)
   • Simulated Consultation Assessment (SCA)
   • Recorded Consultation Assessment (RCA)
2. This policy allows trainees, who have the support of their deanery, to make exceptional fifth attempts at the AKT, SCA or RCA on the basis of additional educational attainment. This policy is approved by the GMC and is in line with their guidance on exceptional attempts.
3. This policy does not apply to trainees who began GP training for the first time from 2 August 2023.
4. The purpose of this policy is to ensure that RCGP is consistent and fair when processing applications for an exceptional fifth attempt at the AKT, SCA and RCA.
5. The decision made by the RCGP will remain valid for 12 months. If a trainee is unable to sit the examination during this period, then a further application with evidence will be required.
6. Exceptional fifth attempts, additional training and ARCP outcomes: A request for an exceptional attempt at the AKT, SCA or RCA if granted by the RCGP, will not confer any right to additional training or be considered as grounds for appeal against any previous ARCP outcome.

7. AKT: Trainees, whether in training or within six months of exit from training without receiving a CCT, who have failed an examination for the fourth time after 1 August 2016 may request an exceptional fifth attempt at the AKT by applying to the RCGP, provided that they meet the eligibility criteria given below.
8. SCA: Trainees, whether in training or within six months of exit from training without receiving a CCT, who have failed an examination for the fourth time after 1 August 2016 may request an exceptional fifth attempt at the SCA by applying to the RCGP, provided that they meet the eligibility criteria given below.
9. RCA: Trainees who are in training and who have failed the RCA for the fourth time after 1 August 2016 may request an exceptional fifth attempt at the RCA by applying to the RCGP, provided that they meet the eligibility criteria given below.
10. The trainee must have passed the AKT in order to be considered for an exceptional fifth attempt at the SCA or RCA.
11. The trainee must have passed the CSA, RCA, or SCA in order to be considered for an exceptional fifth attempt at the AKT.
12. Trainees will not be permitted to make more than five attempts at either the AKT or SCA (including previous attempts at the CSA or RCA).
13. Trainees will not be permitted more than one exceptional attempt at either the AKT or SCA following their exit from training.

14. Applications should be submitted to the RCGP Examinations team.
15. The application form must be completed by the current or most recent Head of GP School or GP Deanery/GP Director who will confirm that either:

    1. additional educational experience has been gained by the trainee since their fourth examination failure and sufficient progress has been made to merit a further attempt

       or

    2. additional educational experience is deemed very likely to be gained, given the declared, planned educational interventions which have been put in place since their fourth examination failure.

       These might include one or more of the following, but the list below is not exhaustive: 

       • a remedial placement has taken place in a different practice
       • intensive examination preparation has been undertaken as approved by the GP School/GP Deanery or RCGP
       • there has been additional language/communication skills teaching
       • the trainee has received relevant additional coaching or other support from a recognised source such as the GP School/GP Deanery or Professional Support Unit

       and

    3. that in the trainee’s (i) final or (ii) most recent Educational Supervisor Report (ESR), the capability domains were rated as (i) competent for licensing (or excellent) or (ii) meeting expectations (or better).

If I have failed one of the examinations four times, but not yet successfully passed the other, can I apply for an exceptional fifth attempt?

No. An application for a fifth attempt is only available to those who have failed one of the examinations but passed the other and have satisfactorily completed Workplace Based Assessment (WPBA). If the result for the other examination is pending you will need to await the outcome before applying.

Can I apply for an exceptional attempt if I have failed only one of the examinations but have not been assessed as being competent for licensing in all 13 capability domains?

 Yes, provided you have not had your final ESR/ARCP. If you have not had your final ESR/ARCP, you must be making satisfactory progress with WPBA and be assessed as ‘meeting expectations,’ or above, in all capability areas. If you have had your final ESR/ARCP you must be assessed as competent for licensing or excellent in all capability areas.

Do the marks from my previous attempts at an examination determine whether I can be considered for an exceptional fifth attempt?

The marks in your previous attempts do not alone determine whether you can be considered. Your application for an exceptional fifth attempt must be supported by your Head of GP School or Deanery/GP Director. It is up to them to make a global assessment and judge whether an additional attempt is merited. However, you must meet the criteria stipulated above.

If I have no training time left, can I still apply for an exceptional fifth attempt?

For the AKT and SCA, yes. If your application is successful, you must make this attempt within six months of exiting training. The form would still need to be completed and submitted by the Head of GP School or Deanery/GP Director and is likely to include evidence from your final ARCP.

For the RCA, you must be in training in order to record and undertake consultations and would need to speak to your GP School/GP Deanery to enable this.

If I am granted an exceptional fifth attempt will the GP School/Deanery give me any additional training time?

The granting of an exceptional fifth attempt at the AKT, SCA or RCA does not confer any right to additional training time. The granting of additional training time is a decision for the GP School/Deanery. As already established for the AKT and SCA some fifth attempts may therefore occur outside GP training and if successful an application through the CEGPR (AP) process would be needed.

Can I apply for an exceptional fifth attempt if I have failed for the fourth time before the 1 August 2016?

No. The regulations only apply prospectively with effect from 1 August 2016.

Can I apply for an exceptional fifth attempt if I began training for the first time from 2 August 2023?

No. The regulations only apply to candidates who began GP training between the dates of 1 August 2016 and 2 August 2023.

Can I apply for an exceptional fifth attempt under both mitigating circumstances and via this route?

No. The RCGP has a clear policy for considering mitigating circumstances that applies to all attempts. Mitigating circumstances must be reported to the RCGP Examinations team as soon as the circumstances arise, or as soon as possible thereafter, and no later than 48 hours after the examination has been sat. It is not intended as a default route for obtaining additional attempts.

Can I apply for an exceptional fifth attempt for any reason other than demonstrating additional educational attainment?

No. This policy allows examination trainees, who have the support of their deanery, to make exceptional fifth attempts at the AKT or SCA/RCA only on the basis of additional educational attainment. It is important that trainees and educators consider the need for any reasonable adjustments in advance of a trainee’s possible exceptional fifth attempt. The RCGP cannot void previous attempts on this basis.

My previous attempts were on the CSA and/or RCA, can I apply for an exceptional fifth attempt on the new SCA?

Yes. The SCA replaces the RCA/CSA as the consultation assessment component of the MRCGP tripos and assesses the same capabilities.

Can I apply for an exceptional fifth attempt on the basis that I was not previously aware of needing reasonable adjustments?

No. This policy allows trainees, who have the support of their deanery, to make an exceptional fifth attempt at the AKT, SCA or RCA only on the basis of additional educational attainment. It is important that trainees and educators consider the need for any reasonable adjustments in advance of a trainee’s possible exceptional fifth attempt. The RCGP cannot void previous attempts on this basis.

If one of my earlier attempts has been voided (i.e., the result has not been issued) can I apply for a fifth attempt?

Yes. Examination results which have been voided are not considered when the number of attempts expended are counted.

Is there any time limit on how long after my last failed attempt I can apply?

There is no time limit, provided that you are still in training. For the AKT and SCA if you have exited training, you would normally be expected to apply for and make an exceptional fifth attempt within six months of exiting training.

Why can’t all trainees have a fifth attempt at the AKT or SCA?

For trainees who entered GP Specialty training after 1 August 2010 a maximum of four attempts at both components is permitted (an exception to this applies to trainees on the Targeted GP Training Programme). This limitation on the number of attempts is evidence based and has been approved by the GMC. This notwithstanding, there is anecdotal evidence that some trainees do succeed at their fifth attempt following educational intervention. Fifth attempts should therefore always be exceptional rather than the norm and on the basis of evidence of sufficient progress following intervention.

Version 1.0 - January 2022

• Written by examinations team
• Policy updated and wording refined to reflect the move from CSA to RCA.
• Currency of decision to remain valid for 12 months.

Version 2.0 - July 2022

• Written by senior examinations manager
• Policy reformatted.

Version 3.0 - August 2023

• Policy updated and wording refined to reflect the introduction of the SCA.

Review date: August 2024 and then annually thereafter.

The following policies, procedures and guidance should be used or referred to when necessary alongside this policy. All policies and templates are available on the RCGP website.

• MRCGP exceptional fifth attempts application form (DOC file, 69 KB)
• MRCGP Regulations for medical practitioners training for a CCT in General Practice