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Doctors with dyslexia are less likely to pass the CSA exam

Doctors with dyslexia are less likely to pass the MRCGP clinical skills assessment (CSA) exam than those who do not have the condition, despite reasonable adjustments being made, according to a study.

The research, published in Medical Education, concluded that more needed to be done to understand the problems encountered by doctors with dyslexia.

Results showed candidates with dyslexia passed the CSA at a rate of 85%, compared with the 96% pass rate of candidates who had never declared dyslexia. 

Researchers at the University of Lincoln looked at a group of 598 exam candidates who declared having dyslexia (2.9% of all candidates) during an eight-year period – 492 of whom declared their condition upon first attempt, and 106 who declared it at a later attempt of the exam.

The researchers compared these candidates with the 20,281 (97.1%) other GP trainees who did not declare dyslexia ‘at any time’. Then the CSA pass rates from 2010 to 2017 were analysed and the two groups compared.

They found that those who had dyslexia were less likely to pass, despite having reasonable adjustments in place – and for those who declared their dyslexia at a later stage, they were even less likely to pass once they had failed the CSA.

Reasonable adjustments, such as allowing extra time or extra paper instead of an iPad, are put in place after a trainee’s condition is confirmed by a psychologist.

Lead author Dr Zahid Asghar from the University of Lincoln said: ‘Doctors with dyslexia, particularly those who declare the condition after failing at least once, possibly because they are unaware of the condition or worried about declaring it, have a higher chance of failing. This suggests we need to understand more about what trainees with dyslexia find difficult about the clinical exam and what can be done to help.’

Professor of general practice at the University of Manchester, Professor Aneez Esmail said: ‘Dyslexia is a broad category. Those with mild are very different from more severe forms in their abilities in exams. If students are qualifying to become doctors, they will have been given some support by their universities – at least in the UK. In order to get the support, they need to have been formally diagnosed – not just self-declared.’

Last year, the same analysis was conducted on the performance of the applied knowledge test (AKT), which found that doctors with dyslexia were no less likely to pass the AKT.

Corresponding author Professor Niroshan Siriwardena, from the University of Lincoln and RCGP research lead for assessment said they have been investigating differential attainment in the MRCGP exam and its causes ‘for some time’.

He added: ‘Our research is beginning to reveal important clues about why certain groups of doctors do less well at certain parts of the exam and what might be done to alleviate this.’

Sessional GP Dr Sudeshna Sar failed her AKT exam three times before declaring her dyslexia and passed the CSA on her second try. She explained that dyslexia affects people in different ways.

She said: ‘There’s a lot of distraction with the CSA. You’ve got two people sitting looking at you, you’ve got a camera going, you’ve got a patient who you know is an actor. Distraction is one of the main issues that dyslexic people struggle with.

‘In my case, I got extra time, I also got a separate room as distraction was a huge issue. Dyslexics often write on a lot of paper so I got a lot of paper, I was given bigger fonts, coloured fonts, because a lot of us deal with number issues with colours.’

Dr Sar added: ‘It’s not just the AKT and the CSA. The issue I found was during training also, doing the portfolio, seeing patients, doing calls. It’s about learning strategies and identifying those issues because dyslexia is very different across the board.’

RCGP chair Professor Helen Stokes-Lampard said: ‘The main purpose of the MRCGP is patient safety, but the College is also mindful of its obligations imposed by the Equality Act 2010 to make reasonable adjustments for disabled candidates and is at all times extremely sympathetic their needs in this regard.

‘The exams section of our website outlines the processes in place for making reasonable adjustments for candidates with a disability, including those with dyslexia.’

In a recent interview with Pulse, incoming RCGP chair Professor Martin Marshall said the exams were not to blame for differences in results. 

He said: ‘The most important thing that we know, from the evaluations that we’ve done and from a growing number of evaluations is that there is no evidence at all that it’s the exam or the exam process which is discriminatory.

‘We know that there’s differential attainment, we regard that as a serious challenge for us, something that we need to understand better than we do at the moment, but there’s no evidence at all that it’s the exam which is the cause of that or the process of the exam which is the cause of that.’

The RCGP has faced criticism recently for not following through with suggestions made to change the CSA exam, with regards to the differential attainment between white and Black and minority ethnic doctors.

The Royal College has previously reviewed the MRCGP exam to determine whether it is ‘fit for purpose.’