Manchester Rating Scales  competency based

This criterion is concerned with the GP registrar’s willingness, ability and skill in gathering information necessary for diagnosis and/or decisions.

follows no routine of history taking.  He/she fails to identify or does not bother to develop salient leads.  He/she will not pursue alternative hypotheses.  He/she does not seek information on clinical, psychological and social factors.  His/her recording is sketchy and not systematic. He/she tends to use investigations in a “blunderbuss” fashion.

takes a comprehensive history, when appropriate, including clinical, psychological and social factors.  He/she examines patients thoroughly using local, regional, systematic or complete examination as appropriate.  His/her investigations are intelligently and economically planned.  He/she records his/her information carefully and uses previous and continuing records intelligently.  He/she plans investigations and uses diagnostic services intelligently.

This criterion is concerned with the GP registrar’s ability and skill in using information gained to develop a diagnosis and support clinical activity.

does not fully realise the implications of the data that he/she collects.  He/she is unable to interpret the unexpected result, which he/she may often ignore and his/her thinking tends to be rigid and unimaginative and impedes his recognition of associated problems.  His/her general shortcomings - rigidly of thought and lack of capacity to range round flexibly, i.e. “diverge”, when thinking over a particular problem that has an inhibiting effect on his/her effectiveness.

realises the importance of unexpected findings and seeks to interpret them.  He/she understands the nature of probability and uses this to assist his/her diagnosis and decision making.  He/she takes all data into account before making a decision and routinely tests alternative hypotheses.  He/she thinks effectively – he/she has the capacity to range flexibly or “diverge” in search for relevant factors in connection with the particular problem in hand and he/she has also the capacity to focus, or “converge”, his/her thinking on whatever factors have been decided upon as relevant.

This criterion is concerned with the GP registrar’s ability to use sound judgement in planning for and carrying out treatment and conveying his advice and opinion to patients.

is concerned more with treatment than the overall welfare of his patients.  He/she plans treatment when not familiar with the procedures or therapy selected.  His/her choice of treatment is rigid.  He/she tends to use set routines or “favourite” prescriptions, whether appropriate or not.  He/she does not explain his proposals in terms understood by his patient.

is familiar with the uses and limitations of the treatment he selects.  He/she recognises his/her own limitations.  He/she considers simple therapy or expectant measures first.  He/she shows regard for the individual patient’s needs wishes and total circumstances.  He/she is flexible and will modify treatment or decisions immediately the clinical situation requires he should do so.  He/she takes his/her patient into his/her confidence and explains his/her proposals in terms appropriate to the individual patient.

This criterion is concerned with the GP registrar’s effectiveness in working with patients.

does not relate well to patients either through aloofness, discourtesy, indifference or pressure of work.  He/she has difficulty in understanding his/her patients’ needs.  He/she is unable to give patients confidence and may even unnecessarily alarm them.  He/she reacts poorly to a patient’s hostile or emotional behaviour.  He/she does not exhibit sympathy or compassion in dealing with patients.

gives patients confidence, affords co-operation and relieves their anxiety.  While patients appreciate his/her interest in their well being the GP registrar does not become emotionally involved.  He/she is honest with the patient and his family.  Patients like him/her and feel he/she is an easy person of whom to ask questions, or with whom they may discuss problems.

This criterion is concerned with the GP registrar’s willingness to accept and fulfil the responsibility for long term patient care.

either loses interest after initial treatment or does not spend time on follow-up care.  He/she becomes discouraged with slow progress and cannot cope with a poor prognosis.  He/she is unable to communicate hard facts to a patient or his relatives.  He/she uses ancillary personnel inadequately or demands greater assistance than they are competent to give him.  He/she fails to review a patient’s care at suitable intervals.

encourages a patient to work for his own rehabilitation and shows that he/she too has the same objective.  He/she observes his patient’s progress and alters management and therapy as required.  He/she understands the roles of ancillary personnel and makes maximum effective use of their help.  He/she maintains a positive and persistent attitude to health and under proper circumstances to recovery.

This criterion is concerned with the GP registrar’s ability to act effectively in emergency situations.

panics easily and loses valuable time by ineffective action.   He/she becomes confused under pressure and has difficulty in establishing priorities.  He/she is unable to delegate appropriate aspects of care to others.  He/she is unable or unwilling to make and sustain decisions alone.

quickly assesses a situation and establishes priorities with full regard to life-saving procedures.  He/she is aware of the consequences of delay.  He/she is able to obtain and organise the assistance of others.  He/she is able and willing to make and sustain decisions alone if necessary.

This criterion is concerned with the GP registrar’s ability to work effectively with his colleagues and members of the health team.

has difficulty in personal relationships and lacks the ability to give and take instruction gracefully.  He/she tends to be tactless or inconsiderate.  He/she is unable to inspire the confidence or co-operation of those with whom he works.  He/she is unwilling to make referrals or seek consultation.  He/she does not support colleagues in their contacts with patients.

gets on well with other people.  He/she is conscious of the need for teamwork and fits in well himself as a member or on occasion as leader of a team.  He/she seeks consultation when appropriate and respects the view of others.  He/she acknowledges the contributions of others.  He/she creates an atmosphere of “working with” not “working for” in other people and demonstrates self-control.

This criterion is concerned with the GP registrar’s  attitudes and standards as an individual member of the medical profession.

He/she discusses medical mismanagement with Patients.

is kind, courteous, honest and humble.  He/she reports accurately, including his own errors. He/she respects the confidence of colleagues and patients.  He/she places patient care above personal considerations.  He/she recognises his own professional capabilities and limitations.

This criterion is concerned with your judgement of the GP registrar’s overall competence as a potential general practitioner, taking into account criterion 1 to 8 inclusive.