Clinical Competency Test (CCT)

The candidate will be allocated a room that will simulate a consultation room. They will see six patients, played by actors.

Of the six patients, four will present with two distinct scenarios (dual-scenario cases), while two patients will present with a single, more complex scenario (single-scenario cases).

Dual Scenario Cases (four):

In the four Dual Scenario cases, the patient will advise the candidate at the outset that they wish to discuss two distinct issues. To open the consultation, the patient will say something like, "There are two issues I'd like to discuss..." Both of the issues within the Dual Scenario cases are marked independently and carry equal weight in the exam.

Single Scenario Cases (two):

At the start of the examination, the candidates will receive a patient-style notes for each of the six cases. Each of the six cases will last 17 minutes, with roughly a three-minute break in between cases. The entire exam will last about two hours.

At the start of the first case, the actor will enter the room with an examiner. The candidate should then engage with the actor/patient as if this was a real consultation and manage the case appropriately. At the end of the 17 minutes, notice will be given and the actor/patient and examiner will leave the room.

The role of the examiner is to observe the candidate and score their performance. There should be no verbal interaction between the candidate and the examiner unless an examiner interjects to provide examination findings/details.

There will be no break during this exam, but if a candidate needs water or to use the toilet as a matter of emergency, they will need to tell the invigilators outside their consultation room, who will pause the exam until the emergency is resolved.

The CCT is designed to reflect what GPs do in their day-to-day practice. As such, the more experience that candidates have in general practice, the better prepared they are likely to be in order to deal with the variety of cases that may arise.

As with the realities of day-to-day practice, the simulated clinical environment can sometimes be impacted by outside factors, such as unexpected noise. Where practicable, the candidate is expected to manage any interruptions of this nature in the same way that they would in day-to-day practice and to continue with the consultation. Any significant interruptions on exam day should be reported to the Exam Team as soon as possible and before you leave the exam floor. 

The CCT aims to assess the competence of general practice registrars when dealing with the situations that may arise in every day Irish general practice. In doing so, it seeks to examine the knowledge, clinical skills (assessment, treatment and communication) and attitudes displayed by registrars as they manage patients presenting in a simulated surgery, home visit or telephone consultation. It examines how they deal with clinical challenges, how they communicate with patients and whether they understand the principles of practice management as applied to the consultation.

The registrars must be able to place the challenge before them in the appropriate context for the patient, their family, the community and their culture, they must display appropriate attitudes based on their professional capabilities, values and ethics. Management decisions must be based on sound scientific evidence where possible.

During the CCT, registrars must show that they have achieved the core competences of Irish general practice as outlined in the core curriculum. They must display a comprehensive understanding of primary care management, the ability to provide person-centred care, specific problem-solving skills, the ability to adopt a comprehensive approach within the consultation, a good awareness of the community orientation of many consultations and the ability to use a bio-psycho-social consultation model, taking into account any cultural and existential dimensions. They must also show that they can reflect on their practice and recognise their own limitations.

Trainees on the Irish and Malaysian Programmes can take the CCT Module in Year 3 or 4 of Training, with minimum of six months in GP rotation. 

Doctors on the Rural International Medical Graduate Programme can take the CCT Module from Year 2.

CCT questions will be based on the core curriculum. The best preparation for the CCT will be gaining experience consulting in a General Practice setting. Extensive exposure over many months to a wide range of clinical cases and scenarios in the final years of their General Practice training should enable candidates to successfully address the challenges of the CCT.

It is recommended that candidates view the CCT Prep Course available on Moodle. 

Candidates are also advised that questions are based on the areas covered by the core curriculum.

View an example of a good CCT Station

You should bring your doctor's bag containing the usual diagnostic equipment with you, including:

• BNF/MIMs
• Stethoscope
• Ophthalmoscope
• Auroscope
• Thermometer
• Patella hammer
• Tape measure

Candidates should not bring any medicines, needles or syringes normally kept in their doctor's bag to the examination. 

An examiner will accompany each role player and will play no part in the consultation, except possibly to hand you information at appropriate points. They will sit outside your line of vision, and you should ignore them. The examiner will be looking at specific aspects of your clinical abilities, marking them on a pre-defined marking schedule. It is possible that an additional observer may be present. They may be performing a quality assurance exercise or merely observing the process. They will take no part in your assessment. It is not permitted to enter into conversation or discussion in relation to a specific case with an examiner. If you do so, you will be in breach of Irish College of GPs Exam Regulations and awarded a fail for that case.

The CCT Examination is currently held in the RCSI Simulation Lab at 26 York Street, Dublin 2. Candidates will be assigned an arrival time following registration. The ICGP aims to follow these times as closely as possible, however delays, whilst regrettable, are sometimes unavoidable and you should take this into account.

Once you have checked in at the registration desk, you will not be permitted to leave the candidate waiting room and briefing area. Please note that mobile phone use is strictly prohibited from the point that you enter the briefing room. If you bring any electronic devices to the examination your will be required to hand them over for safe-keeping prior to entering the candidate briefing room. Any candidate found to be using a mobile phone under exam conditions will be considered to be in breach of ICGP Examination Regulations and will be awarded a fail.

Preference for registration will be given to fourth year trainees and repeats as available places are limited for this examination.