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Gold, incentives and meh

In full: RCGP initiatives to tackle MRCGP inequalities

The RCGP has begun a range of initiatives to tackle unequal pass rates for international versus UK medical graduates - read about the changes here

In full: RCGP council report on tackling MRCGP inequalities

Readers' comments (3)

  • What's going to happen to lots of candidates who have been signed off competent in final ARCP but failed CSA mostly by one to three marks as result of this difference between Uk graduates and International graduates markings. A majority have been already released from the training and doing other hospital posts as a source of continuing medical practice and financial support for their family. This CSA exam has destroyed lives of so many international doctors. I hope RCGP comes to terms and brings all those doctors back to practice as GP especially in this situation of GP crisis. If RCGP does not do anything to address the discrepancy of pass rates the institution is going to loose credibility and loose a lot of devoted competent doctors. Why have Eportfolio and WBAs as well as CSA when their excellence is not taken into granting CCT. CSA should be desirable but not compulsory to be licensed as GP. I hope many of you who read this agree. Please put your comments. We have to raise our voices to be heard and all as a big team to confront RCGP to do the right thing.

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  • The above is excellent comment as it shows empathy towards the victims of CSA exam, but the ignorance of RCGP. I completely agree with it. I am sure many local experienced practice nurses would pass CSA exam after training for 1-2 years. When it comes to licensing, RCGP gets very narrow minded although they talk about holistic approach in all other occasions. If passing CSA makes a competent doctor, then there is no need for training doctors, just train experienced practice nurses. I think that finally the time would come that some people would be accountable if RCGP doesn’t give a chance to those poor GP- registrars who didn’t passing CSA by 1-3 marks, but did very well in AKT and WBAs. I think RCGP needs strongly think about bringing back the victims of CSA exam, especially at the time when there is GP workforce crisis (recruitment, retention). Let,s not further deprive our patients from the care of very good doctors who didn’t pass CSA by 1-3 marks, but work at the NHS hospitals to help patients and support their families financially.

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  • I completely agree with the 2 comments above. The CSA is weighted heavily, and favours certain candidates over others (or at least the examiners are unable to give credit where it is due for certain candidates when marking - it seems empathy and soft skills are favoured highly over appropriate patient centred case management (which is what general practice is all about). I advise my trainees to lay it on thicker that they usually would in real life as it goes a long way to bumping up those CSA marks. Trainees often do that anyway "just for the exam, and then afterwards I can go back to normal". It really ought to be called the Communication Skills Assessment, as I've seen poor trainees slide through with poor AKT results (some have failed 3+times) but high CSA marks with a scattering of crosses in their feedback showing that overall they had problems with a range of competencies but not enough to fail them).

    I've examined for 3rd year medical students at university who have communication skills teaching. They're very good at it. They would be able to clear pass a range of CSA cases which seems quite ridiculous given that this is a specialist exam.

    The issue with the CSA is probably more with how it is marked. Clearly it is not marked in the same way that the COTs are marked, as there seems to be a lot of benefit-of-the-doubt given to some candidates. I only realise this as I sat the exam myself and surprisingly got a great mark. Though coming out of the exam I felt I did badly, thinking about how I'd not done each case as perfectly as the COT competence criteria outline. Which is where the "benefit of the doubt" fits in.

    Having seen a number of competent (as far as I could tell) IMG trainees fail at the very last hurdle, I sense that examiners struggle to give those candidates the benefit of the doubt for some reason when marking each domain.

    During a local RCGP CSA prep course I attended, I found that different examiners (and these were examiners who actually examined in the CSA) seemed to mark differently, which was frustrating for us trainees who tried to understand what was important. For example by not getting enough info on social hx or concerns, some examiners deducted marks from data gathering AND interpersonal skills (i.e. penalised twice) whereas others deducted from info gathering only.

    I do think it is time for RCGP to reconsider how and why they may decide to kick out good would-be GPs, because RCGP have unknowingly lost some really good, hard-working GPs who would have complimented the GP workforce. Instead, those trainees have walked away feeling a sense of injustice whilst being led to believe that despite all their hard work, progress and engagement with the training process, that the CSA says they're not good enough, and this impacts hugely on their self esteem. As the 2 comments allude to above, it really does ruin people's lives.

    There will always be candidates who are truly poor and not deserving of passing, but RCGP and their representatives (the examiners, the local leads in training) need to stop being so defensive about it and start looking at this more objectively. Trainers who have seen their trainees over a 12m period surely have a greater grasp of the level of competence their trainees have over an exam with dubious marking over a day.

    I really do believe the CSA tool could be a good one for assessing competence, but presently, it needs reviewing to make it more fair and representative in marking of candidates competence levels. I think RCGP's fear of being sued has prevented this from happening. However, it cannot carry on.

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