By Ian QuinnExclusive: The RCGP toughened up a key part of its entrance exam without seeking regulatory approval and failed to warn trainers it expected the number of GPs qualifying to fall, a Pulse investigation reveals.Leaked documents show the college did not obtain the required sign-off from the GMC for a ‘major change' to its clinical skills assessment, which contributed to the pass rate plunging from 81% in 2009 to just 46% last September.GPs warned the slump in pass rates had left training practices seriously overburdened, exacerbated the scramble for training places and worsened the current shortages of candidates for jobs.The documents show that while the college publicly blamed the fall on the poor quality of candidates in the cohort, it had privately predicted a 10% fall in pass rates, aimed at weeding out poor GPs who might threaten ‘public safety'. It also knew foreign doctors would be particularly affected. A letter obtained by Pulse, sent by GMC chief executive Niall Dickson to RCGP chair Dr Clare Gerada, reveals the GMC was forced to call in lawyers to investigate the results, amid concern they could be open to challenge. The letter says the college should have acquired ‘regulatory approval' for its switch to the borderline-group marking system, which made it more difficult for borderline cases to pass. The GMC said the revamp ‘was a major change', but had apparently been wrongly interpreted as a ‘minor change' by the now defunct Postgraduate Medical Education Training Board.In his letter, Mr Dickson rejects the case for the September results to be revisited, although new results for November and December show pass rates have risen back up to 63%, with one source convinced the bar was moved again.The RCGP blamed the crash in the pass rate last September on ‘the cohort rather than the assessment' and its website claims the changes were made to maximise reliability of results and make the system ‘fairer to candidates'.However, a separate letter circulated by Dr Sue Rendel, interim chief examiner for the RCGP, reveals the college made the change in direct response to a request from the PMETB for ‘more careful scrutiny to ensure public safety', and modelled as long ago as March 2010 a 10% fall in the pass rate. The letter says the college's research had found international and non-white candidates fared less well in both the CSA and applied knowledge test elements of the MRCGP, and admits because borderline cases are more likely to be international candidates ‘there will be a disproportionate decrease in pass rates in that group'.The RCGP still maintains it went through the correct processes in bringing in the change, but admits it was ‘emotionally unintelligent' in its communication of the likely impact on candidates. ‘The RCGP regrets there were perceived difficulties in communication with deaneries,' it adds.Dr Nigel Giam, a GP trainer in Little Venice, north-west London, said: ‘I don't think the college has been transparent. If it knew the pass rate was going to fall it should have communicated that to trainers. The message never came across.'Dr Bill Reith, chair of the RCGP Postgraduate Training Board, said: ‘The safety of patients is and must remain our priority. The PMETB encouraged the RCGP to introduce a system for the CSA paying more attention to candidates at the pass-fail borderline. The change makes no difference to candidates taking the exam.'Ups and downs of CSA pass rates Ups and downs of CSA pass rates Dr Nigel Giam
