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Sociolinguistic factors affecting performance in the Clinical Skills Assessment of the MRCGP: a mixed methods approach

Hawthorne, Kamila; Roberts, Celia; Atkins, Sarah


Kamila Hawthorne

Celia Roberts

Sarah Atkins


Background: Differential performance in clinical skills assessments is a widespread phenomenon, for which there remain few explanations.

Aim: To better understand the conversational contexts of simulated consultations and how candidates actually behave in these consultations and to determine sociolinguistic factors for high and low-performing candidates.

Design & setting: Taking the Membership of the Royal College of General Practitioners’ (MRCGP) clinical skills assessment (CSA) examination as a model, this research applied sociolinguistic analyses to case videos of 198 consecutive candidates presenting for the CSA examination. Method: Using a mixed-methods approach, both quantitative and qualitative sociolinguistics methodologies were combined to analyse video consultations, and findings were compared with those from group discussions with MRCGP examiners.

Results: There is more ‘talk’ in simulated consultations than in real life. On macroanalysis, there was little difference between poor- and well-performing candidates. However, microanalysis found subtle differences in structuring consultations, metacommunication, picking up cues, and misunderstandings with and giving explanations to patients. Formulaic talk, contrary to examiners’ perceptions was more common in successful candidates, but it was personalised and sited appropriately in the consultation.

Conclusion: This is an interactionally demanding form of clinical assessment, that requires giving support to candidates and a more analytic approach to the development of interpersonal skills. Sociolinguistic features of consulting to help trainers and candidates prepare for the CSA are identified.


Hawthorne, K., Roberts, C., & Atkins, S. (2017). Sociolinguistic factors affecting performance in the Clinical Skills Assessment of the MRCGP: a mixed methods approach. BJGP Open, 1(1),

Journal Article Type Article
Acceptance Date Aug 26, 2016
Online Publication Date Apr 4, 2017
Publication Date Feb 15, 2017
Deposit Date Feb 20, 2018
Publicly Available Date Feb 20, 2018
Journal BJGP Open
Electronic ISSN 2398-3795
Publisher Royal College of General Practitioners
Peer Reviewed Peer Reviewed
Volume 1
Issue 1
Keywords simulated consultations; communication skills; assessment; sociolinguistics; general practice
Public URL
Publisher URL


Atkins 2017 - Sociolinguistic factors affecting performance in the clinical skills assessment of the MRCGP.pdf (317 Kb)

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