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Trainees aren’t going to pay for exams on a whim

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I’m glad to have recently passed my AKT. Dare I say it, some of the revision was even enjoyable.

I thought the exam was very fair, and our Royal College spends a significant amount of time ensuring that it is. However, in a previous blog I mentioned that variation is the scourge of medical training. In the case of the AKT, there’s significant variation in how GP trainees are able to adequately prepare for the exam – and I suspect that this means there’s variation in how well they’re able to perform.

The current exam rules allow the AKT to be sat when you’re an ST2 or ST3. The argument is that it’s better for you to have had some GP experience before you sit the exam. However, there are some trainees that don’t have a GP rotation til the second half of their ST2 year, but are able to, and do, sit the exam prior to experiencing general practice.

This rule matters because the vast majority of hospital posts have an on-call element. Consequently, the average working week is around 48 hours. In general practice posts, the average working week is 40 hours.

My solution is to open up exams for trainees to sit whenever they want

If you have the ability to revise for an exam when you have less work to do, that’s going to be an advantage. There are many trainees who have their first GP rotation of six months in their ST1 year, instead of their ST2 year. The exam regulations simply don’t provide these trainees with the choice of using that post, with fewer work hours, to revise for the AKT.

The MRCGP is pass or fail, and no-one will care how well you passed your AKT after you obtain your CCT. You could reasonably argue that that all this doesn’t actually matter. But my trainer recently made me aware that there’s a prize for trainees who perform well in the MRCGP – which includes their exam performance. Not that such an award is necessarily reflective of the ‘best’ or ‘good’ trainees, but given that there isn’t equality of exam opportunity, I think there’s a problem with this award.

My solution is to open up exams for trainees to sit whenever they want. Financially, it costs for trainees to sit these exams, and the CSA remains the single most-expensive exam in postgraduate medical training. We aren’t going to choose to pay for these on a whim.

Given the non-linearity of modern medical training, there are lots of GP trainees who come with prior experience from other training programmes or an FY3 year in the antipodes. Many could sit and pass the AKT in the first year if given the opportunity, so let them.

Secret trainee is a GP registrar in England