I believe the RCGP's current clinical skills assessment is failing international medical graduates. Here are the RCGP results from September – and they are shocking.
Some 417 candidates sat CSA examinations between 19 and 24 September, 150 (36%) of whom were first-time applicants. In all, 230 candidates were successful, resulting in an overall pass rate of 55.2%.
The pass rate for first-time applicants was, however, 83.3%, which compares favourably with a pass rate of 79.8% for first-time takers in February/March 2011.
Of 267 candidates taking the exam for the second time or more, 106 (40%) passed. Some 29 candidates were making a fifth attempt or more at the exam, and of these just 11 (38%) were successful.
The mean score for the entire cohort was 75 out of 117, with the highest score being 110 marks. The minimum score achieved was just 31 marks, with 15 candidates scoring 20 or more marks below the passing mark – just three of these were on their first attempt, four were on their second, five on their third, two on their fourth and one on their eighth attempt.
I believe the majority of continued failures are international medical graduates, but that is anecdotal rather than confirmed from the published results, although we have been told that international medical graduates are struggling.
My personal feeling is that the CSA is potentially biased against them. As a consultation skill test it is very likely to be easier to find faults with people, and with international medical graduates this is easier than with UK graduates. With the old system of submission of videos, we shared the best practice of a candidate. This is no longer the case, and it is easy to fail. With the bar being raised 12 months ago, this has been made worse.
The current cohort that entered the training at ST1 with a certain understanding of the process and examinations ahead will have been compromised by the change in CSA standards that took place 12 months ago. I am not sure that change has been beneficial.
The RCGP appears to want a standard that seems too high, and justifies the results by looking at first-time sitters without clearly understanding the problems faced by those sitting the exam multiple times.
The stress and financial pressure are taking their toll on some retaking this exam. Failure rates of 60% seem particularly high. I'm not surprised that the exam remains hard if you fail the first time – the pressure to pass it becomes greater with each attempt. Restricting attempts to three or four will just mean losing some good doctors now and in the future.
As a trainer, I am not happy as this examination appears not to reflect evidence seen in the workplace. At least with hospital posts there is the option to work as a staff-grade doctor. In general practice after you have one or at most two extensions you are cut loose.
I am not sure what can be done about this other than adjusting the pass mark.
The CSA is a good assessment of consultation skills until you factor in multiple failures, stress and international medical graduates – then it appears to miss something and not reflect what is seen in practice.
From Dr Steve Taylor
GP trainer
Prestwich, Manchester
