Technical problems and the row over the CSA should not be allowed to overshadow our progress in making training more robust, flexible and thorough, says RCGP chair Dr Clare Gerada
The saying goes that there’s no such thing as bad publicity, but I’ve had cause to question this over the past few weeks as the college has dominated the pages of Pulse with issues surrounding the MRCGP exam. Rather than going on the defensive at every turn, I felt it was important to keep a watching brief, but I now think it’s time to tell our side of the story.
I’ll start with the clinical skills assessment and the change in its standard-setting methodology. The RCGP constantly strives to refine its processes and introduced this change to provide even fairer, more robust, standard setting.
We took advice from the previous regulator (the PMETB), three international assessment experts, and from a review commissioned from Peninsula Medical School. All of these sources advised we should move from a ‘number to pass’ methodology (where candidates have to pass a specified number of cases), to a ‘borderline group’ method.
We also added marks from the 13th station (previously used to trial new cases) to improve the assessment’s reliability. The borderline-group method benefits candidates, since we can take account of variability in difficulty of cases on a daily basis. And it benefits patients, because we have greater precision in setting an appropriate pass mark, ensuring only those we’re confident are competent will pass.
As fair as possible
I appreciate these changes have caused confusion among some trainees and trainers – particularly candidates taking the exam in September 2010, the first sitting using the new methodology. The college has, as a goodwill gesture, refunded application fees to those candidates who were narrowly unsuccessful in September and those who have yet to pass have been offered a free training course. While we apologise for any anxiety caused, we stand by the rigorous-ness of our assessments.
I believe we owe it to our trainees, members, and ultimately our patients, to ensure our assessments are as thorough as possible.
The college has also received questions about the fairness of the CSA, particularly in candidates who obtained their medical degrees overseas. The RCGP has undertaken considerable research to ensure our examination is fair to all candidates, and we’re currently working closely with King’s College London to examine whether cultural and linguistic factors may affect performance in the CSA. Differing pass rates for UK and non-UK graduates occur across medical specialties, not just general practice, but it is a priority to do all we can to ensure GP assessment is rigorous and fair.
A complex world
The technical glitches we have had with the trainee e-portfolio have now been ironed out. We moved to a new server in mid-March, resolving the stability and speed problems, and have increased our helpdesk staff so trainees can get through more quickly if they have queries.
I am also delighted to report that the case for extended GP training is firmly back on the agenda. Our GP curriculum provides an excellent launch pad for new GPs. But the world of general practice grows ever more complex, both clinically and politically with the health reforms, and we need to ensure the next generations are fully confident, as well as competent. Over the next few months, we will be preparing our re-submission, arguing for extended training.
I also want to re-open the debate on GPs, predominantly women, who are returning to general practice after taking time out to have families or career breaks. It appears to be so hit and miss whether there is funding for re-entry schemes back into general practice – and with the current reforms and cuts in funding, this will only get worse. I will try to see how re-entry can be simplified and made more flexible, and how GPs needing retraining can be funded.
As things stand, we are losing brilliant doctors from our profession, and I won’t just stand back and allow this to happen.
Dr Clare Gerada is chair of the RCGP and a GP in Kennington, south London
Dr Clare Gerada