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Pressure growing on RCGP to justify its pass rate

By Richard Hoey

The college blames a halving in the pass rate for its CSA exam on a poor cohort on candidates - but it needs to work much harder to persuade GPs of its argument, says Pulse editor By Richard Hoey

Three years ago, the pass rate for the RCGP's clinical skills assessment stood at 93%. Now it's half that, after an initial decline to 79%, and now an alarming slump to just 46%.

So what's to blame? Is it simply a result of a poor quality of candidates, as the RCGP suggests? Payback perhaps for half a decade of pay freezes and media denigration, which have seen the number of applicants for general practice plummet, and left the profession with second-choice, maybe even second-class, candidates?

Well, perhaps. But it's fair to say that the majority of the many GPs responding to our story - most, but certainly not all, registrars – are unconvinced. Our letter of the week is from Dr Gary Cherrill in Nottinghamshire, a trainer for more than 20 years, who insists he is seeing good candidates failing the new exam.

So, what if the candidates aren't to blame? Does that lead us naturally to hypothesis 2, espoused by Dr Cherrill, that the college may have toughened up its exam?

There has even been the odd suggestion that it could be benefiting financially from doing so, thanks to its healthy fees for resits. Then again, that has tended to come from candidates who have just failed the exam – and therefore have a rather glaring vested interest in casting aspersions on its fairness.

There is another hypothesis, that doesn't rely on tougher exams or less talented candidates. What if this year's candidates are no better or no worse than any other year's, but just happen to be rather worse prepared?

The GMC has after all been grumbling about the quality of medical education, and the RCGP has been worried for some time that GP training didn't do enough to instil confidence in registrars, even if it's unlikely to go so far as to suggest courses may no longer instil sufficient competence.

All is not well at deaneries up and down the country either, although you'll have to wait a few days for more details on this one.

But this is all just so much speculation. All we know at the moment are the bald facts – a CSA pass rate in the autumn cohort that has fallen from 81% to just 46% in a single year.

Hard, stark stats like that can't just be speculated away. The RCGP needs to conduct its planned post-mortem as promptly as possible, and provide a strong, reasoned argument to explain away the fall.

Otherwise, the college will find confidence in it, at least among registrars, slipping as fast as its pass rates.

By Richard Hoey, Pulse editor