Muhammad Navaid Ahmed
That is exactly the point. The whole process was designed to demonstrate ongoing competence at keeping oneself up to date, but all it does is show you are doing something about it as you just mentioned i.e. fill in the form and be able to turn up to the prerequisite number of meetings etc. Keep doing it as long as it works, otherwise believe me there could be worse alternatives e.g. yearly knowledge tests, communication skills assessments, yearly patients and peers feedbacks etc.
I do not find appraisal and revalidation daunting. If you can keep on top of it from the beginning it should not be as time consuming as many colleagues make it out to be.
In my opinion it is a good way of demonstrating what self-learning you have done for the year,what new things you have learned about, and what you found difficult to deal with and how will you manage this in future. You do not have to be very eloquent or depressingly exasperated in order to reflect. Simple and focused sentences should do and hence the fact less than 1% doctors are actually sent for remedial action.
If you start the whole process with antagonism and negativity, you will find it harder and harder each passing year. I qualified as a GP three years ago and maybe i am more familiar to eportfolos and written reflection than some of the older colleagues, and that might be causing some problem? Whatever the reasons, the appraisal is probably one way of demonstrating competence (agree may not be the best way but there has to be some objective way of proving ongoing competence in the modern World) or else are you guys prepared to go through competency exams?
The fact of the matter is a majority of electorate chose the Tories. The Conservative party has been given the mendate to push forward and implement their policies thay had already started in their first term in the government.
It is very sad to say how far and alienated the GPs prospective and views are from the general public. At the end of the day we are Public Sector employees and bound to respect and follow what our public wants from us.
Offcourse if some of us do not want to do this can withdraw from Public service and go private or abroad. But please accept the will of the people and learn to adapt.
This is not ideal for us the GPs but this is a fact and the sooner we accept it and move on the better.
Just to add a few comments:
1) You do not prescribe antibiotics (and rightly so), patient complains, you still have to accept and reflect on 'your inability to convince the patient antibiotics not needed, its your fault.
2) You have a difficult consultation, you try to do your best to convince the patient what you are doing is best for them, they still make complain, again you have to accept you did not address their concerns adequately and so the complaint.
3) You eventually decide to give in, prescribe the unneeded medicine, or make an unneccesary referral, you get the blame for over-prescribing the antibiotics or sending in innappropraite referrals.
What do you do? You try to take the middle ground, decline the ones who are not the complaining nature, and give in to those who shout the loudest. You might be relatively safe...but, will you enjoy working this?
I know my answer!
Please note I am not doubting those colleagues's ability as Doctors.....but this si not quite the same as GPs.
I have seen numerus colleagues failing the exams, getting extensions into the training and than eventually passing it. I have never seen any Doctor being removed from the training due to constant failures.
This just makes me feel the colleagues who have actually been out of traning despite several attempts and extensions in their training, were they really meant to be GPs?
This is ludicrous! Female part-time GPs are extremely vaulable in every aspect of general practice. Their communication skills, ability to bond with vulnerable and anxious female patients, their knowledge about sexual health and female issues, and their loyalty and commitment towards the practices is indisputable. And women are women, they will marry and have children, and will work part-time. I would not want my wife to work from 8 to 6 everyday when got two little kids at home who need beng looked after. Besides, many male GPs work part-time, infact many people decide to go into general practice because they wanted to have flexibility in their work pattern.
The problem does not lie with female GPS, the problem lies wit some of the Tory politicians. These politicians like to play politics of blame and scaremongering. They somebody has to take blame for whatever that has gone wrong. Be it the immigrants, policies of previous government, the EU, lazy GPs or even hard-working female doctors who are trying to balance wirk with raising families and generating the high-fliers of future generation.
I am sick and tired of people posting anonymously in these fora. The Pulse was supposed to be a respectable and professional journalistic medium through which educated and well-mannered people talked with logic and compassion.
Now what we got are countless name-less, face-less entities throwing mud at each other with no rumorse or sense of responsibility. Shame on all these people. If you are frightened of the consequences of sepeaking up, then dont open your mouths, truth is self-sustained, it does not need your cowardly advocation.
I passed, thanks to Almighty Allah. Second attempt 81/117.
IMG pakistani graduate.
Been to the CSA today. All the scenarios were really realistic. The role-players were professional and infact helped in stearing me towards main topic. There was a good ethnic mix among examiners and some of them infact smiled a few times.
As far as I am concerned, I made blunders, stupid mistakes and at times went through phases of mental blocks. I am not used to of long simulated exams unlike local grads, and so found the exam much tougher. If I fail, I can tell you i've got only one person to blame, and it is not the college, examiners or the actors.....
CSA is an exam that tests your ability to provide a 'good experience' to actors playing up patients. It is not really a knowledge exam, infact getting the diagnosis or management right is not the main priority (as it is impossible for a certain group of candidates to get all diagnoses right but they still seem to have near perfect pass rate), it is all about providing the patient the best possible experience. This is the way the college wants to see the 21st Century GPs act and perform. This is more of a customer focused approach, and this is not wrong either, as General Practice is a publically funded entity, and the Government wants the GPs to act in a certain manner that is totally eubmissive to the needsand demands of the patient and where declining a request needs to be handled in an extremely sophasticated manner for which high-end communication is essential.
Candidates who are unble to act/fake/dodge their way out of this standard will find it difficult to pass.
To the British Asian Doctor who has pasted above.
I totally agree with whatever you are saying, the CSA is totally an acting exam and is being used to churn out hurds after hurds of GPs who all act and talk in a particular manner that is more presentable and 'customer-focused', rather than 'problem-based'.
A also agree that acting lessons do improve communication skilla and this has already been proven with Doctors through research.
Dear Dr Gerada
Thanks for your response, I am afraid, I am only concerned with my present college i.e. RCGP, though I am also a full member of the Royal College of Physicians, and never found the level of distrust and dusgruntlemant in its trainees that i sense in many of trainee colleagues affilated with the RCGP.
I am sorry if you feel you are slated for publishing the figures. The point about discrimination, prejudice and bias is that they are not perceived by those who are not being subjected to them. And discrimination is not usually intentional: it is about what attributes, behaviours etc are assumed to be normative. When people come along who do not fit that norm, they are usually expected to fit into it as best they can, e.g. the first women MP's having to use the gents' toilets because there were no ladies' loos in the House of Commons and no intention to provide any. What then follows is a lot of harrumphing about it being too difficult to change it etc until the minority are present in sufficient numbers to justify change and have pointed out the ways in which "the way we've always done it" disadvantages them.
So when you're devising something from scratch, like a new exam format or a revalidation process, you build in an equality impact assessment right at the beginning and consult representatives from all protected categories to ask if they can foresee any ways in which this new exam, process or whatever might be disproportionately difficult for them. In your training process you then address this. And if your diversity monitoring picks up evidence that one particular subgroup is disproportionately struggling, you find out why. If it's an essential part of whatever you're trying to create, then you have to conclude that some subgroups of the population, even with maximum support, training etc just cannot do or be this kind of person. But you would have to make very sure you'd corrected and eliminated all the sources of bias first and make the whole process lot more transparent as well. E.g. Video-taping consulting and allowing candidates to use them for appeals and remedial training. Also auditing the marking practices of different examiners is very important, so is holding them accountable for not awarding full marks or 'clear pass' to certain group of candidates even when they do not make any mistakes and do not get any crosses over any of the competency areas. This makes a huge difference between pass and fail.
The Equality Act is still quite new remember so a lot of organisations are still getting their heads round it and thinking of equality and diversity as the tee-hee-hee bit that gets tacked on at the end rather than being embedded in the design. Unfortunately the College seems to have managed to create an exit exam that *does* disadvantage a subgroup of the profession, what we don't quite know yet is how. We also don't know whether whatever it is testing is an essential component of being a "UK GP" because most UK GP's currently practising have not sat it. (Some returners have, I believe, be interesting to know how they got on.........?)
In the end, I would say I can feel your dilemma, the emotional turmoil and the guilt that you feel in your heart about this CSA fiasco. I am sure you never intended things to unfold in that manner that they have, and whatever that has happened was not meant to be in the beginning when the process was started. But, now as it has become very clear that the CSA is an intrinsically flawed exam, why not take the initiative? Why not do something about it? Do you feel resistance from some of your deputies? Or you find it difficult to accept the shortfalls of the exam?
Time is running out Dr Gerada, please take the right decision, please tear down this wall, please dismantle the CSA exam in its current shape and form. In the end, you have this peace, this realisation that you have done the RIGHT thing.
An error does not become truth by reason of multiplied propagation, nor does truth become error because nobody sees it. Truth stands, even if there be no public support. It is self sustained.
Dear Dr Gerada
Could you please provide us with the following figures if you could:
1) what is the break-down of all trainees now out of training due to repeated CSA exam failures in terms of their ethnic background and PMQ?
2) what are the respective pass rates for CSA exam for White British, BME and IMG trainee doctors in years 2011 and 2012?
3) would you agree to the conclusion that in a hypothetical situation if all GP trainees were white British, the pass rate will be very close to 100%?
4) do you have any figures about the percentage of IMG Doctors scoring Pass in atleast eight of the 13 stations and still failing the exam?
An affected GP trainee.
Dear Zishan Syed,
No I do not have a Pass in CSA, attempted it once, and failed it once.
My views on CSA exam in my earlier post still do not change.
I am an IMG, but I do not belive the college or some of the examiners are racist or discriminate against the IMGs.
I am a CSA failure myself, failed it once, but I do know that you need to have excellent communication and linguitic skills to pass this exam. These things come naturally to local white graduates, even more so than local non-white graduates. I know I am a very good doctor, but communication is something very different. I will not be surprised if a white practice nurse manages to pass this exam with flying colors. Another fact is that many of us have a developed a very rigid style of consultation, and practising role-plays for few months is not going to ractify this. Women are generally better commnicators than man as reflected my CSA pass statistics.
I wish we the IMGs, collectively as a group think hard and carefully before joining general practice training. Many of us are very good clinical doctors, not necessarily communicators. It is not as easy for us to look at out flaws than to point fingers at others. Nobody can fail you four times just beacuse of your background. Maybe, some of us are just not good enough in a particular and important GP skill-set, it is not at all a reflection on our ability to work as safe and competent doctors in other specialties.