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Scotland Deanery

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Frequently asked questions - Enhanced Induction

If it is established that I am suitable and eligible to be considered for the GP Enhanced Induction Programme, what happens next?

  • You will be required to undertake more formalised assessment through validated Multiple Choice Question (MCQ) papers which assess knowledge and values.
  • You will be required to sit the simulated surgery.
  • Your assessments enable NES and the Health Board Medical Director to identify whether you are suitable for acceptance onto the programme and have the potential to successfully contribute to General Practice in Scotland.
  • Your assessments also help to determine the length of workplace experience and clinical supervision required up to a maximum of six months (whole time equivalent).
  • If offered a placement then you will be included on the Performers' List as "in training for a fixed period".
  • If you wish to take up the offer of a placement, funding will be applied for and a suitable GP placement will be identified. 

What does the MCQ involve?

  • The MCQ is a computer based test delivered across the UK by computer using Pearson Vue testing centres and also some venues outside the UK. The assessments are held four times a year. You will be able to schedule a place at your nearest test centre once your application has been accepted. There is a fee of £150. You are allowed a maximum of four attempts. The Clinical Knowledge Test and Professional Dilemmas Test form the two parts of this exam. The schedule of sittings in the UK is published on the NRO website.
  • The Deanery Educational Adviser will advise on how you can book a place. 

What do the results of the MCQ mean?

The aim of the GP Enhanced Induction Programme is to provide a period of supervised practice that seeks to support applicants and bridge any gaps in their knowledge or skills relating to General Practice in Scotland. Depending on the outcome of your MCQ scores, applicants are awarded a banding which helps determine the structure and duration of the educational placement required for each individual.

Guide to scores for candidates

The MCQ assessment consists of two papers - a Clinical Problem Solving paper (CPS), which requires the application of clinical knowledge, and the Professional Dilemmas paper (PD), which explores your approach to work. The PD paper measures competencies such as Coping with Pressure, Empathy, and Sensitivity and Professional Integrity. The papers have been rigorously developed and researched to help in the selection of candidates onto the Induction & Refresher scheme.

Responses across all questions are totalled to give a single score. There are no subdivisions within either test. For the PD paper, you receive more points the closer your response is to that of an expert panel of GPs. Only questions where there is consensus between experts regarding the correct response are used.

Your final scores are determined by comparing your performance to a group of other similar applicants to GP training posts. The use of a comparison group allows your performance to be benchmarked. The comparison is acheived by converting your score to a T score scale with a mean of 50 and a standard deviation of 10. This allows the scores for both papers to be compared. 

A minimum passing score for each paper has been determined to be a T score of 46, based on a standard setting exercise. Around 33% of candidates can be expected to score below this level on average. 

T scores have been assigned to 5 bands. Band 1 contains those scores which are well below the determined minimum cut score. Band 2 is scores which while still below the determined minimum are closer to the required standard. 

Band 3 contains scores that range from the cut score to the mean score. This band represents an acceptable, but below average level of performance. Band 4 ranges from the mean to one standard deviation above the mean. This is the broadest band and reflects a good level of performance on the paper. Band 5 is the highest band and scores in this band are well above the average.

Your score band shows how well you are performing compared to other candidates. Scores in Bands 1 and 2 suggest that substantial areas of performance need to be addressed. Scores in Band 3 suggest an adequate level of performance that is sufficient to progress an application for the Enhanced Induction Programme. However, candidates scoring in this band are likely to benefit from work to improve the relevant skills. 

Scores in Bands 4 and 5 show a good to excellent level of performance.

Band 1 scores on either paper suggest substantial deficiencies in performance.

Band 1, 2 and 3 scores on the CPS paper suggest a need to brush up clinical knowledge. Some candidates may find their knowledge has deteriorated through lack of use. Others may need to update their knowledge. Low scores on the CPS paper may also be due to poor problem solving skills, that is difficulty applying knowledge in clinical situations. This can include difficulties in identifying the key issues in a situation, poor integration of knowledge or failure to determine the most likely or critical possibilities in a situation.

Band 1, 2 and 3 scores on the PD paper suggest a difficulty in identifying the best response to situations. This may be the result of inappropriate assumptions about the role of a doctor both in the provision of care and as part of an organisation providing clinical care. This can include a poor understanding of professional ethics or use of less patient-centred approaches to the provision of care. Candidates with scores in this band may sometimes fail to take account of how others are feeling, have difficulty making decisions under pressure or cope less well with the stresses and strains of being a medical practitioner.

Allocation of scores to bands

Band Approximate percentage in band T score range Interpretation
Band 1   12% 38 and below Well below the minimum standard
Band 2   19% 39-45 Below the minimum standard required
Band 3   19% 46-50 Adequate level of performance
Band 4   32% 51-59 Good level of performance
Band 5   18% 60 and above Excellent level of performance


Those applying for the Scotland GP Enhanced Induction Programme must achieve a score of at least 46. 

Those scoring less than 46 (Band 1 and 2) may resit the MCQ up to 4 times in total. If they fail to achieve the required mark after four attempts they will not be offered a place on the enhanced induction programme, this result will be shared with the Health Board Medical Director and career advice will be offered. 

Those scoring 46 and above (Bands 3, 4, 5) demonstrate a good level of knowledge but require an additional assessment of their consultation skills. They will be invited to sit a Simulated Surgery assessment.

This assessment will determine the nature and period of a funded placement (up to three months, whole time equivalent WTE) in the first instance, which will be reviewed by the GP Adviser who will recommend whether a further three months will be required. The maximum time spent by the doctor in supervised practice will be six months.

If you score a Band 4 or 5 you will not be required to sit the Simulated Surgery and will be accepted directly onto the Enhanced Induction programme.

What does the Simulated Patient Surgery Involve?

  • Simulated surgeries are held quarterly at the RCGP examination centre in London. The schedule of assessments is published on the NRO website. 
  • The purpose of the assessments is to determine your suitability for the scheme and the appropriate length of scheme up to 6 months whole time equivalent. All candidates taking the simulated surgery are provided with feedback about their performance to inform their learning needs and professional development planning. These are held 4 times a year in London usually 4-6 weeks after the MCQ. There is a fee of £850. You are allowed a maximum of 2 attempts.
  • The GP NRO will provide further information about both assessments, including example assessments and answers to frequently asked questions once your application has been received. Simulated Surgery: Candidate Notes
  • The Royal Medical Benevolent Fund - www.rmbf.org - or the Cameron fund http://www.cameronfund.org.uk/ may be able to provide financial assistance for the GP Induction & Refresher assessments

Costs of the MCQ and Simulated Surgery will be borne by the applicant.

When can i sit these assessments?

MCQ Assessment dates can be found here.

Simulated Surgery dates can be found here. 

What happens next?

Once you have successfully completed these assessments and have your results, you must make an appointment to meet your NES GP Associate Advisor whom you met earlier in the process. Your start date on the programme will be subject to the availability of funding and a suitable placement. 

In order to undertake the programme, you will need to be registered on the Performer's List as being "in training for a fixed period".

What happens if I fail to reach the standard required to be eligible for the programme?

If you fail to reach the standard required, then you will be offered career advice from the NES GP Advisor. This will provide you with information about other options that might be available to you. 

How will a practice be found for me?

The practice to which you will be attached will be a GMC approved training practice with experience of teaching and assessments. The GP Unit will offer you a practice that as closely as possible suits your situation however the actual location is dependent upon availability. 

What is the role of the supervisor?

Your supervisor will be an experienced GP Educator who will establish your educational needs and construct an educational contract to address these. This will describe the number of clinical sessions you will be expected to do every week, your programme and timetable for completing assessments and clinical and educational supervision arrangements.

Will my supervisor be paid?

Your supervisor will be paid a standard trainer's grant (pro rata if you are part time)

Do I have to pay the supervisor myself?

 No, this payment will be made to your training practice by NHS Education for Scotland.