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The waiting game

GP trainees locked out of MRCGP exam could get 'sixth' attempt

Exclusive The RCGP is considering adding a further sixth attempt at its end of training Clinical Skills Assessment for doctors who have been locked out of general practice by being unable to complete the final exam.

The RCGP told Pulse it was considering the changes in conjunction with education bosses’ plans for a ‘Targeted GP Training’ (TGPT) programme to support doctors unable to pass the CSA or changing specialty.

Black and minority ethnic doctor representatives said requiring trainees to pay ‘almost £2,000’ for another retake did nothing to address fundamental issues with the exam which mean non-white doctors are much less likely to pass.

But the BMA’s GP trainee committee was more hopeful, saying that the individual education support package in the programme could be the difference, rather than ‘doing the same thing over and over again.’

Tthe RCGP only allows four attempts but in August 2016 began allowing a fifth ‘in exceptional circumstances’.

Dr Ramesh Mehta, chair of the British Association of Physicians of Indian Origin (BAPIO), said that College representatives were receptive to the idea of allowing failed CSA candidates toretake the exam after been locked out of training in a meeting last week. 

He told Pulse: ‘They said that there is a possibility that the number of attempts, which is four at the moment [with a fifth in exceptional circumstances], is going to go up to six.'

However, he said that the RCGP continued to insist that BAPIO's proposed changes to its exam, such as providing video feedback to unsuccessful applicants or using two examiners to correct for bias, were ‘too expensive’.

Dr Mehta added: 'The amount of money they charge for these exams is nearly £2,000 and these poor trainees pay every attempt. But they [the RCGP] are saying their exam is making a loss.’

RCGP chair Professor Helen Stokes-Lampard said changes to the exam are ‘unlikely to be implemented’ before it has heard back independent review of the MRCGP’s first ten years – as revealed by Pulse.

The College meets regularly met BAPIO and others to ensure ‘all elements of the assessment remain fair to all candidates’ and she added: ‘During our last meeting with BAPIO, the possibility of further attempts at the Applied Knowledge Test or Clinical Skills Assessment was discussed in the context of potential Targeted GP Training proposals being considered by HEE – but until these are published we are not in a position to make any decisions or comments.’

GPC education, training and workforce lead Dr Krishna Kasaraneni told Pulse that ‘simply adding more and more attempts isn’t going to serve a purpose’.

‘I’ve spoken against it before, because what's the point of doing the same thing again and again without extra support or added focussed training.

’But this scenario is looking at people who have been unsuccessful in the past and have used up all their attempts but putting them through the targeted training programme and giving them a chance to get through the assessment.’

The TGPT programme is working to identify how many GPs could benefit having failed before, but Pulse revealed last year that RCGP records showed around 400 doctors had hit the maximum attempt threshold.

The talks between BAPIO and the RCGP follows a High Court challenge by the association three years ago which ruled the College’s exam was lawful but that action was needed to address the gap.

But last week Pulse revealed that the College’s own figures show it is the widest ever recorded in the MRCGP qualification’s ten-year history.


Readers' comments (26)

  • Why have any limits on the amount of times you can take these exams ?

    This would take the psychological pressure off candidates.

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  • Not the financial pressure

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  • If you cannot pass it in 5 sittings you aren't going to pass the 6th.

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  • why are non whites unable to pass this CSA. I still do not understand what the problem is.
    Can anybody please explain.

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  • We really are desperate for more GPs. If u allow someone to sit it that often, then what's the point.

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  • Cobblers

    Bit like a driving test. Six times has to make me think a bit whether the driver and the car are suited.

    And would I travel in the car with them?

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  • What is the reason for failing to pass that exam after 6 years of studies/training??!!
    Don't the initial formation during 6 years is correct??
    This last exam should be a formality if teaching done correctly....

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  • Peter Swinyard

    if you do what you always done, you get what you always got. Perhaps there are some 400 doctors who are never going to be good enough to be GPs. Perhaps there are 400 doctors who cannot cope with the exam format and should be enabled to another route to passing a test to be allowed to be GPs. Perhaps there should be a "staff grade" for those who have been through the training mill yet cannot pass the exam but who could work under supervision? How many doctors repeatedly fail FRCS or MRCP? What happens to these doctors? Do they all end up as staff grade in A&E? It seems such a waste of some good people.

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  • Complex issue requiring evidence-based solution. "Staff-grade" parallel attractive option Chairman wise to proceed carefully. High Primary Care standards must not be diluted.

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    Bring back the old CCT GP CERT
    Time and experience based entry into general practice

    General practice is about working smart you can always look up what you need to
    Real world pragmatic solutions are needed
    to resolve the workload and recruitment crisis

    Compulsory GMC Fee and RCGP exam is just a monopoly money earner for them

    Oh Yeah some of us got locked out of MRCG by the old exam changing to the new exam

    Anyway no regrets at not having payed membership fees for the privelidge of a few letters

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  • Tom Caldwell

    The statistics on your chance of passing at a six attempt were... catastrophically bad. These were candidates who had intensive extra help and input. How is this different to the previous farce of six attempts.

    It seems like an expensive way to destroy more souls.

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  • The trouble is that too many trainees having failed once rush into entering the next exam. Practice "textbook" cases with a ghetto of other overseas graduates and don't listen to their trainees saying what they need to change. I have seen it time and time again. It's often not their knowledge although the AKT results aren't fantastic often because nuances are missed and speed isn't excellent.It isn't their work ethic either which is usually excellent. However my experience is that if not passed by 6th attempt then often truly aweful

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  • Why have an exam at all eh?!! Jesus wept.

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  • Vinci Ho

    (1)'To help the weak and aid the needy' . I am not the most religious person but I think that is one of teachings of Jesus Christ , isn't it , Helen?
    (2) 'Too expensive ' to have video recordings and two examiners . Seriously, money is really the most important argument here?
    (3) Then a good breakdown of how the money ,acquired from examination fees and continuing membership , was spent should be published. Transparency, please .
    Yes , you can call me a anti-establishment demagogue,(can't be more worse than Trump anyway).......

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  • The stats on the gap of attainment between White UK entrants and 'the rest' is truly staggering. Surely an exam that discriminates so much against minorities has no place in the 21st century?

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  • re Sunshine 4.10- about as ill-informed as it is possible to get.

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  • I'm getting a bit sick of this. Look at the statistical analysis freely available on the results of the MACHINE MARKED AKT.

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  • It seems to be the CSA where people fall down. We've had a number of reasonable candidates fail and a high court judge expressed concerns even though the BAPIO case was not a technical 'win.' Why is it ill-informed to point out discrimination where it is obviously occurring?

    This is a controversial and unpopular exam. Even if you can explain the foreign candidates failure rate on cultural differences that doesn't really do it for the UK BME group. The MRCGP needs reforming and replacing with something that is more suitable to the well documented challenges of modern general practice where the government's consumer agenda is wreaking havoc.

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  • If it takes you more than five attempts to pass this pathetic exam you should probably quit medicine.

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  • Vote of no confidence in RCGP long overdue

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  • Its all about color these days.Look whats happening in America.
    Its a shame on all of us in 21st century.

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  • doctordog.

    We should realise that possession of this Mickey Mouse exam from an irrelevant organisation is not a marker of quality, knowledge or ability .

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  • Why pay at all? This craze for a RCGP tail and having to pay a permanent levy for membership of an obsolete, damaging to GP organisation is incomprehensible.

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  • I have recently sat and passed this exam... It is not a test of medical knowledge, it is a test of communication according to the principles endorsed by the RCGP (not my position to comment whether these are correct or not).
    This makes it a game for which you can specifically train, recognising the balancing act between ultimate 'shared decision making' and the intricacies of working in the National Health Shambles of the 21st century.
    The patients are professional actors (another group with a huge underrepresentation of BME individuals) therefore the cases are limited by the actors available (attempting age / sex / gender / race appropriate for cases). Again this limits the likely cases which allows better preparation.
    This exam is stressful, all exams are stressful, but part of the day job involves dealing with stressful circumstances (even as a Reg I have these experiences daily) therefore if the candidate can't cope with the stress of the exam how will they cope with a busy surgery?
    Does this make the CSA a cultural exam, I suppose it does because the examiners are looking for a culturally sensitive and appropriate response to the difficult day to day decisions we need to make as GPs. Society expects doctors and specifically GPs to fit with local cultural 'norms' which I believe the CSA attempts to recognise. Does this make it a 'Racist' exam?
    I have huge respect for anyone practicing medicine, particularly a speciality with communication at its core, not in their first language. I am proficient in French, would probably pass a PLAB equivalent, but would never dream of taking post graduate exams there unless I had spent many years immersed in their culture and health care service.
    Apologies for my rambling, rest assured that post CCT the RCGP will not receive a penny more from me!

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  • The strange thing about all the statstestics regarding BME failing mrcgp is in stark contrast to other royal college exams.Secondly how many white doctors will be able to pass the exams in India,Pakistan,Africa,if the exam was more social base then medicine based.....yes they learn the British etiquette but it is never enough.......the base of the exam is flawed........

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  • I clearly cannot understand why these ex trainees be given another way to prove their every building to have mandatory fire exit....why can't there be other ways....some people are definitely not cut for this exam format.....and surely these trainees are a better bet then being seen by a nurse or physician assistant. Dr.Lampard... please change the exams.

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