It is possible to justify toughening up the clinical skills assessment, but the RCGP should have communicated it’s intention to the profession.
When the RCGP revamped its clinical skills assessment last September, it released some helpful guidance for concerned trainers and registrars.
The document, entitled ‘FAQs and common misconceptions’, began with a reassuring observation: ‘Please note that no fundamental change has taken place to the CSA.’ That claim now looks hard to defend. As we reveal this week, the GMC has written to the RCGP to inform it that introduction of the borderline-group marking scheme did, in fact, constitute a ‘major change’, and that regulatory approval should have been sought before making it.
That could be dismissed as the bureaucracy of training and education playing itself out, if it hadn’t had such a dramatic impact on the profession. The pass rate for the CSA collapsed from 81% to 46% after introduction of the new assessment, leaving registrars dismayed, training practices overburdened and general practice even shorter of new recruits than it had been before. Pass rates were particularly low for foreign and ethnic-minority doctors, fuelling further recriminations.
The college has been forced to admit it ‘regrets’ failing to properly warn deaneries of the implications of the changes. But its failures of communication run deeper. Even after the slump in pass rates, it resolutely refused to blame the new exam, pointing the finger instead at the quality of the candidates. ‘We think it’s to do with the cohort rather than the assessment,’ said Dr Mike Bewick, chair of the RCGP assessment committee. It’s hard not to see those comments as a touch disingenuous, given the revelation in RCGP documents obtained by Pulse that the college had modelled the possibility of a 10% fall in pass rates as a result of the changes.
It is clear from the college’s internal communications that changes to the CSA were made not for obscure educational reasons, but through a straightforward desire from the old PMETB (now amalgamated into the GMC) to toughen up standards. One document insists the standard examiners mark has not changed, but admits borderline-group marking was introduced with the expectation of failing more candidates: ‘This was instigated after a review by PMETB, who requested the CSA look at changing its standard-setting methodology to ensure candidates around the pass mark were more carefully scrutinised to ensure public safety.’
That this was the driving force behind the change was heavily diluted in the college’s communications with the outside world. Dr Nigel Giam, a GP trainer, insists: ‘The message never came across.’
There are some profound lessons for the RCGP, and indeed for the GMC, from this episode. It might be possible to justify a toughening up of the entrance exam on the grounds of driving up standards. But that is an argument we need to hear – the profession needs to be consulted, the implications discussed, and GP trainers and trainees need to be alerted. The college must embrace far greater transparency, and make changes in education and training in partnership with the profession, rather than imposing them upon it.