Test of Competence

Check that the information in your EPQ accurately corresponds with your clinical case notes. Assessors spend many hours going through the documentation and will notice any discrepancies. 

Make use of the allocated word count when putting your documentation together. TOC assessors want to really see how you practice as a clinician so the more detail the better. 

The TOC is not a quick process. On average, a pack of evidence from a candidate is around 80 to 100 pages of documentation so give yourself at least two to three months to put together a good quality document. 

You will need to know all the relevant legislation that the GCC lists on the website, so take time to study before your test.

When selecting your three long clinical cases, choose cases that you know extremely well and feel very confident discussing. 

Learn from other applicants who have been required to provide further evidence in the past. The most common subject areas requested are:

• the quality of patient clinical records
• appropriate use of ionising radiation
• evaluating patient care using outcome measures
• understanding of the biopsychosocial model
• evidence-based practice
• patient safety and risk factors (red and yellow flags)

I qualified as a chiropractor in 2019 in New Zealand, studying in both ⁣France and New Zealand. After practicing for five years, I made the ⁣decision to move to the UK to be closer to my family. ⁣There is a perception that the Test of Competence is very difficult, and ⁣that the failure rate is high but in reality, that’s not true. Speaking with ⁣other graduates about their experience of taking the Test was very ⁣reassuring. ⁣
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To be successful you need months rather than weeks to prepare and ⁣study. I spent eight months preparing my application and immediately ⁣after submitting it I began to study for the interview. It is a lot of work. ⁣
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Having good clinical cases and being confident in your understanding of ⁣these cases is very important. I initially chose cases that were very ⁣complex and special because I thought they were amazing cases, but this ⁣is not the best approach. It’s better to choose cases that are more ⁣straightforward and easier to discuss during the interview. ⁣In addition to understanding your clinical cases you must also have good ⁣knowledge of the different chiropractic guidelines and relevant legislation. ⁣
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There is quite a lot to learn but the Royal College of Chiropractors’ online ⁣learning Test of Competence module is a useful resource. ⁣During the interview you will be asked to discuss a specific scenario. As ⁣part of my preparation, I found it very helpful to discuss different ⁣scenarios with colleagues to test my critical thinking. ⁣
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Following the interview, I was asked to provide further evidence ⁣demonstrating my understanding of UK standards for record keeping, as ⁣well as to reflect on areas identified for ongoing professional development. ⁣
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I believe this is a reasonable and constructive approach, offering an ⁣opportunity to clarify and strengthen areas that may benefit from further ⁣reflection. ⁣

1.Transcript from the educational institution which awarded your chiropractic qualification. 

The transcript must give details of how it meets the registration requirements and include: 

• your full name 

• your chiropractic qualification 

• the date you achieved your qualification 

• a list of course codes and names 

• the total number of study hours (this is not the grades or points). This can include clinic hours and nominal hours allocated for self-directed learning. If this does not appear on the transcript, you will need to provide an additional letter from the college giving the total course hours. We cannot accept course or module descriptions with the study hours; we need confirmation that you have completed the study hours. 

Please refer to our rules on the qualification requirements for overseas applicants here. If you have not completed the relevant number of hours, you may still be able to apply depending on your circumstances. Cases will be reviewed on an individual basis. 

2.  The Evidence of Practice Questionnaire (EPQ) 
The Evidence of Practice Questionnaire (download here) provides evidence of how you meet the standards in The Code of Professional Practice, benchmarked at the level of the learning outcomes detailed in the GCC Education Standards. The questionnaire forms a key part of your application and will be assessed by the Test of Competence Assessment Panel. 

All the answers given must be entirely your own work. Should there be any suspicion of collusion with others and/or copying the work of others, then your application to join the register may be refused. For further information, read our Plagiarism and Collusion Policy and Procedure. 

As well as documenting your past or current practice, the responses that you give should also outline how you intend to ensure compliance with the COPP in similar circumstances. Give enough detail to reassure the panel that you understand the reasons behind your practice and the rationale for any care you provided. 

3. Anonymised patient records 

You must upload an anonymised set of patient records to support your answers to Sections 2, 3 and 4 of the Evidence of Practice Questionnaire. These must include everything that is part of the patient record, including details of the initial consultation, all the subsequent treatment notes, any reports, images or letters, as well as any intake or administrative forms that the patient was provided with. 

Patient records are a compulsory part of your supporting evidence. You will not be able to attend the TOC interview without providing them. 

4. CV/Resume 
You must upload an up-to-date copy of your CV/Resume that includes all your work history, especially related to chiropractic. 

5. Passport Copy 
Upload a copy of the pages from your passport that contain your photo and personal details. 

6.  Diversity 
You are invited to complete the online ethnicity and diversity form as part of the application.

Important
Patient records are a compulsory part of your supporting evidence. You will not be able to attend the TOC interview without providing them. For further information, read our Anonymised Patient Records Policy

Additional Information 

English Language Skills 

There are some circumstances, such as if the chiropractic programme you attended was not conducted in English, when we will ask you to provide evidence that you meet the English Language requirements (see our Guidance on English language skills for applicants). Please ensure you review the guidance to ensure your application is not delayed. 

After Receiving your Information 

Once we have received your application and the test fee, we will check to ensure that you have provided all the information that is requested. We will then confirm an interview place or let you know if any information is missing. Any request for further information may result in a delay to your application, and you may miss the closing deadline. 

Withdrawal and Refunds 

Once you have had a TOC interview place confirmed, a withdrawal of your application up to 24 hours before the closing date will result in a 50% refund of your fee. No refund will be provided after the closing date, unless we agree that you have an exceptional mitigating circumstance. 

After you have uploaded your completed application to our portal, including the Evidence of Practice Questionnaire, you will be required to attend a TOC Assessment Interview. We will send you information confirming the date and time of your interview after the closing date for applications has passed.  

The role of the interview panel is to assess whether you have the knowledge, skills, understanding and attitudes to practise in accordance with the COPP and supporting Guidance, benchmarked against the programme outcomes in the Education Standards. While we use a standardised criteria for the interviews, a significant number of the questions that you will be asked will be specific to the answers that you provided in your Evidence of Practice Questionnaire.  

What to expect at the interview 

You should allow up to 2 hours for the interview. This will include sufficient time to deal with potential internet connectivity issues which may increase the length of interview. The interview itself will consist of three separate parts: 

1. The Evidence of Practice Questionnaire 

The panel will ask questions to explore the information that you have provided in your Evidence of Practice Questionnaire. You will need to be able to explain the rationale behind how you have practised in the past, and to reflect on what changes you might make if you were to practise in the UK. This section will comprise at least 50% of the interview. 

2. An Ethical Dilemma 

The panel will then provide you with a hypothetical situation to explore how you would approach an ethical dilemma. You will be given plenty of time to read and consider the scenario, before being asked some questions by the panel. This section is intended to investigate how you would handle a challenging situation, which may address areas such as: prioritising a patient’s wellbeing, handling your professional responsibilities, dealing with conflicts of interest, working within professional boundaries, consent and confidentiality, or fulfilling the duty of candour. 

3. The Code of Professional Practice and Practising in the UK 

In the final section of the interview, the panel will ask a series of questions to assess your knowledge and understanding of  The Code of Professional Practice and supporting Guidance, as well the UK healthcare environment and relevant legislation. The questions are heavily influenced by the result of analysis carried out to identify the main differences between the UK standards, and those of other regulatory authorities around the world (details of these areas are provided in the Support For Applicants section). 

On the day of the interview 

The interview will be held remotely, and we will send you a Microsoft Teams link in advance of the interview. We will need to carry out an identity check prior to the interview starting (please see below for the documents required), therefore please use the link to connect to Microsoft Teams 5 minutes before the interview is due to begin. You will initially enter a virtual lobby until the panel is ready. 

IMPORTANT: There are a few things that you need to arrange before the interview starts: 

• A good broadband connection will be necessary, as you will need both your camera and microphone to be switched on during the interview (if your internet is unreliable, you may find it helpful to connect your device directly to the router). 

• You must be in a room on your own, where you will not be disturbed, and you must not be in contact with anyone else. 

• You will need a copy of your completed Evidence of Practice Questionnaire and anonymised patient records, as you may need to refer to them. However, you must not refer to any other material during the course of the interview. 

• It is not permitted to record the interview. If the interview is recorded it will be treated as serious and you will automatically fail the TOC, or be treated as a disciplinary matter if you have been registered. 

• You must have identification with you, which we will need to visually check before your interview can begin. The following are the only forms of identification we will accept, and they must be original, current, include a recent photograph, and be the same as the document you provided as part of your TOC application: 

• your passport 

• your UK Immigration and Nationality Department identification document 

• your Home Office travel document 

• your UK driving licence 

• your EU identity card 

If the name on your identification document is different from that on the confirmation you receive from us offering you an interview, you must provide original evidence that you are the person named in the letter. We will accept: 

• your marriage certificate 

• a declaration from the awarding body which granted your chiropractic qualification, stating that both names relate to you 

If you cannot provide the necessary document(s), you will not be allowed to sit the interview. 

We will inform you of the outcome of your Test of Competence (TOC) application by email within 10 working days of your interview. The GCC does not enter into correspondence on outcomes of the Test of Competence but does provide feedback to candidates.  

• Pass - you have supplied sufficient evidence of meeting the standards set out in The Code, and are therefore eligible to apply for registration.
• Further Evidence Required - there is insufficient evidence of meeting the standards in one or more specific areas. However, following the submission of satisfactory further evidence (specified by the panel) you will then be allowed to pass and proceed to registration.
• Fail - there is insufficient evidence of meeting the standards in a large number of areas, and/or concerns about patient safety, and you will need to make a new application and resit the whole TOC.

The GCC does not enter into correspondence on outcomes of the Test of Competence, but does provide feedback to candidates.

Deadline for Submitting Further Evidence

If the result of your TOC is 'Further Evidence Required', you will be given specific details of what you need to do. This further evidence must be provided within 6 months of the TOC interview. Despite this deadline, we have found that applicants who supply this evidence within 3 months of the interview have a much better chance of passing than those who take longer.

Application for Registration

After passing the TOC, you will need to apply for registration. Before we grant you registration, you will need to make sure that your application for registration is complete. Our registrations team will normally get in touch with you once they have received notification of your pass.

What happens if I fail?

If you fail the TOC, you will be notified and receive a copy of the assessment report. The report provides you with feedback, giving details of areas where the panel found you were weak. The report may also suggest a time-frame in which you should revise before re-applying for the TOC, depending on how much work is required by you. We strongly suggest you review the report and revise, taking into consideration any time-frame given, before again attempting the TOC. The Evidence of Practice Questionnaire and patient records you submitted, are deleted from the portal and you will need to submit those again, as revised, as well as pay the TOC fee being securing a space on the interview.

TOC Complaint Procedure

We have a complaints procedure in place where a TOC candidate has concerns that processes, either for the TOC or the TOC administration, have not been fully followed. These are set out below:

Stage 1: If you have a complaint about the TOC, in the first instance, you should put your complaint in writing, addressed to the Registrations Lead (toc@gcc-uk.org).

Stage 2: Following Stage 1, and where you are unsatisfied that due process has been followed, or you wish to make a complaint about an administration matter, you may take a complaint to the Registrar. This must be made in writing and addressed to the Chief Executive and Registrar (chiefexec@gcc-uk.org).

Stage 3: There is no formal right of appeal against the Registrar’s decision to accept a TOC assessment panel’s recommendation about the outcome of a TOC. If you wish to challenge such a decision, you would need to apply to the Court for permission to have the decision judicially reviewed.

If you are unsatisfied by the Registrar’s response to a complaint about the TOC process, you may wish to make a complaint to the Chair of the GCC Education Committee. Such a complaint represents the final stage of our internal complaints process about such matters. If you remain unsatisfied following the Chair of the Education Committee’s consideration of your complaint, you may wish to raise your concern with the body that oversees the work of the UK regulators of health and care professionals, the Professional Standards Authority.

The Code of Professional Practice and Education Standards 

The COPP outlines the standards that chiropractors must meet if they wish to practise in the UK. It is important that all those wishing to sit the TOC are familiar with, and fully understand, the Principles and Standards within the COPP and are able to apply it to their practice. 

We also publish a range of additional guidance and information which include important professional requirements to help chiropractors remain compliant with the COPP. This can be found at the Registrants Resource Centre. 

In order to pass the TOC, candidates are expected to have at least the same level of knowledge as a newly qualified UK chiropractor. Our Education Standards set out the criteria that chiropractic students in the UK must meet in order to qualify.  

Learning Resources / Modules 

The Royal College of Chiropractors has developed an online module specifically aimed at those preparing for the TOC. The Royal College has also published a series of chiropractic standards that may provide further assistance for those preparing to work in the UK. 

Information on Practising in the UK 

In addition to the evidence that you present in your Evidence of Practice Questionnaire and supporting documents, the TOC will focus on the core values identified by patients and chiropractors (values that underpin the Code of Professional Practice), together with knowledge of the UK healthcare system and relevant legislation. This is defined as:

1. Patient-centred care - prioritising patients’ needs, preferences and values through individualised care, shared decision-making and clear, effective communication and consent processes
2. Safety and quality
   • Research and evidence-based practice - critical appraisal of current research and the best quality of evidence available to inform decision-making and support best practice
   • Evaluating chiropractic care - continuously monitoring patients through reassessment and review, adapting care plans as needed, and promoting public health
   • Continuous quality improvement - evaluating practice to identify, plan and implement improvements to clinical practice, systems, and patient outcomes
   • Safety and risk - promote safety by managing risk, including safety incident reporting and the duty of candour, first aid, and understanding the implications of relevant medications
3. Professionalism (including honesty, integrity and transparency) - demonstrating behaviours and attitudes that reflect a commitment to ethical practice, putting the interest of patient’s first, and upholding the reputation of the profession
4. Healthcare system in the UK - understanding of the UK healthcare environment, the chiropractor’s role within it, and their collaboration with other healthcare professionals

1. UK legislation, including: the Equality Act 2010, the Data Protection Act 2018 and UK GDPR, the Children Act 1989 and Children Act 2004, Mental Capacity Act 2005, Health and Safety at Work Act 1974, Ionising Radiation (Medical Exposure) Regulations 2017 and IR(ME)R 2018 (Amendment), and local safeguarding regulations