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Debate No.5 (Sep/Oct 2002) - MRCPsych Exams

16 posts in this topic

A timely discussion! Rant and rave as appropriate.

Debate: THE MRCPsych EXAMS SHOULD BE ABOLISHED

The knowledge required to succeed in the MRCPsych exams has little relevance to the skills needed to be a good psychiatrist. The exams are a pointless hurdle in the career path of a psychiatrist.

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Well, the purpose of exams is not really to give us knowledge, or even to test if we know stuff; just to test whether we really care enough about our careers, or little enough about the reat of our lives, to puit ourselves through the ordeal.

By the same token, our ability at A-level is clearly of little relevance to our ability at removing appendices, gall bladders, and beads from children's noses, particualrly those of us clever enough to have studied only maths and physics.

Infact, to consider that we need any training, other than the ability to affect a nice suit and convincing manner, before we surge forth to prescribe creosote to all and sundry, is to miss the finer points of doctoring and professionalism all in.

Exams are fun, mainly when they are finished, and likewise usually seem easy at this point. these two worthy thoughts enable us to feel special for passing whatever we pass (or even blessed to be able to stand (or sit) at the gateway to our futures) and finally, in the midst of all the worthy thought that they instill inus about ourselves, they help us to be cynical about life. Which is like bitterness, but less well adjusted, and so very helpful for talking to one's relatives.

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Conversely (from a more sociological viewpoint), having difficult postgraduate exams with esoteric knowledge and considerable expense is supposed to enhance the status of a profession in society.

(Doens't seem to be working though does it ??!! :-/ )

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i think, rather obliquely and inelegantly, i was trying to make a similar point. i suppose my point, however, is that it is not society that needs to hold a profession in high esteem for it to be a 'Profession', but its members who must radiate their own self esteem.

it is our own doubt in the fact that the exams and qualifications we hold do not entitle us to maintain our demigog status that makes us vulnerable to the insults of society and politics...after all, we are still the most trusted profession around. myself, i blame evidence based medicine for enlightening us to our own shortcomings.

i'm not wholly convinced that the average member of society knows his MRCPsych from his elbow. and so it should be. if we struggle to make the exams relevant to ourselves what hope for joe pubic. what they might smell is the whiff of elitism about us, having passed our exams (as we surely all will)

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I wonder if, when the examiners set the questions, they are thinking :

I'm glad I know this

I wish I knew this

In 10 years time I'll be glad to know this

I used to know this

Everyone else should know this

I had to know this and so should you

Does anyone know this ?

This will ensure that only 30% get through

Only those who read my textbook will know this

I wish I'd known this before X happened

Look what I found out today !

???

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the majority of questions, which are outside of the scope of normal experience, seem to rely on a trick of the light that allows in a critical word in the proposiition, about which there may be some doubt. there is a happily mindless quality about the way in which such questions are distributed that suggests there is little active thought in their derivation, but rather a process of trawling recommended texts, and extracting, then randomising, all binary concepts into examinable form.

the nature of the key word always seems to be that it 'sounds like' or 'has a derivative menaing somewhat like' the word which would accurately complete the propostion affirmatively. the exceptions seem to be those where the alteration to the sense of the proposition is such as to be wholly absurd, even beyond the realm of metaphysical possibility.

the only thought, therefore, that could be on anyone's mind when preparing a sentiment such as this is the laudable:

'I'm really clever'

which hopefully all examiners know is the only truth that really needs to be justified by candidates.

post modern reply please.

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i got promoted by posting the same thing several times, i really am clever, oh yes... 8)

[but not that clever - excess posts removed by the all powerful, all conquering Webmaster  ;)]

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Yes, the validity of the examination as an appropriate discriminator between the 'heep'and the 'goats'

is difficult.

It is admirable that there are some doctors around able to turn their back on these professional examinations and lead highly fruitful careers of considerable benefit to the patients we all exist to serve without this examination.

Most of the rest of us struggle with this issue but blindly 'follow the sheep' by entering for the exam and hoping for the best.

Examinations are clearly an integral part of post-graduate training across Medicine and Psychiatry is part and parcel of that 'culture.' There is a need for a whole sale evaluation of medical culture before this changes and that is quite a lot to hope for.

What might work (- some hope -) is for the Royal Colleges to come to the realisation that the attrition rate of trainees in Psychiatry is worsened by this examination system. In due course - if current shortages persist - crisis point will be reached and this might force change.

It is - of course - always easy to criticise and to do so without alternative suggestions is fruitless : There clearly needs to be an exmination system which determines passage from basic specialist training into higher training. This system must however be fair and the Royal College should be seeking further impartial educational advice. I was encourgaed by the recent educationalist's report on the examinations although was also concurrently somehwat surprised by its lack of criticism of the current system.

I am unusual in that I am both psychiatric trainee and educationalist (with qualifications and experience as a professional educator) and have many concerns about the validity of this educational structure. It is doubtful that an examination system such as this is would survuive the scrutiny to which school based public exminations are undergoing currently. I have been directly involved in GCSE and A level examinations and have been greatly impressed at the then Boards'

efforts to ensure fair play. Although I know rather less of the behind the scenes work within the Royal COllege of Psychiatrists ; I am doubtful that there is a similar effort to achieve an appropriate differentaitaion behind he 'good' and 'bad' candidates.

There is a moral imperative involved in examining candidates both to demarcate between the ood and the bad as well (within an evaluative training culture ) to facilitate and enable the progress of those not reaching that fair standard. Not only would this be 'best practice' but it would also yield numerous rewards for the Royal Colleges in the future in overseeing the professional development of trainee psychiatrists.

Very practically my suggestions would be :

1. Elements of continuous assessment invovling College Tutors.

2. The development within formal summative assessment procedures of differentiation strategies based not on menaingless minutiae but on real significant issues of clinical competence.

3. A fair and open feedback service to allow for failed examination attempts to be a true learning experience. There is a need to develop the feedback service in this direction.

Linked to these issue are of course the examination costs involved and it would be very encouraging if the actual costs of these examinations reflected - and were seen to reflect - the cost to the Royal College rather more convinvingly.

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Part of the problem with an exam designed to distinguish genuine competence is, that the majority of one's colleagues are, indeed, extremely competent. Also, of course, that in spite of the responsibility and rather solitary pursuits in the upper echelons of one's career, that one is rarely obliged to make an evaluation unarmed by reference materials and colleagues as non-examinable resources (perhaps a luxury more avaliable to psychiatrists than surgeons) Therfore to create an exam situation which accurately reflected the skills needed to bve a competent clinician would perhaps prove difficult if it were to have any discriminartory value.

The arbitrary, and admittedly somewhat punitive, assessment of minutae of fact is an assessment of one's commitment to work, one's willingness to follow accepted principles, and to be under suffrage in order to enter a professional body. The hope is that these things could be extrapolated into the daily striveing for good parctice through similar commitment.

Of course the inducement to take one's exams is the progression in career status, and this may not be a lasting incentive. The CPD process in theory establkishes the need for this to be a continuous process. ObviouslY, CPD is imprefect, being peer rated, relying on self report, and subject to interpersonal biasses (I'm sure these are rarely significant problems, but the transparency of the matter in an atmosphere of public distrust and waning confidence is paramount.) Clearly these would be potential flaaws in the matter of continuing assessment as part of the training requirement.

Implementing strategies to ensure fairness, such as the protocaol referred to for the new format PMPs (thanks webmaster, great link) raises the risk of creating artificially homogenous situations fro assessment which can be learned and prepared for with the same arbitrariness as the MCQs. Clearly a degree of unpredictability, and indeed unfairness, is crucial for creating a metaphor for daily work and life.

In summary, it seems you're damned if you do and you're damned if you don't, in regard to post graduate exams. It is easier to conceive of them as entrance criteria for a moderately expensive, and exclusive, club, with clear membership benefits, rather than as a necessary part of service to one's clientelle. A suitably rigourous training program, not encumbered by a fear of sanctioning incompetence without blame or lack of compassion, would be an environemtn with greater respect for trainees, and let the college set its own rules separately...

dx

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All three of C.H.Morgans suggestions above are fantastic. I wonder if you have written to the college about this. With your experience in the area of education you would be speaking I presume with authority on the subject and they may listen. Your proposals make logical sense to me.

With regard to your third proposal I think this could be extended. Shouldn't the college Tutors have responsibility in supporting trainees at this time in particular, after they have failed. I was blessed to pass part one first time, but have seen many ahead of me and contemporaries retaking numerous times. They get no specific help from tutors and their health has suffered in all but one case that I can think of. Yet many are doctors that will make good psychiatrists but have given up or stopped training.

Surely in the Royal College of Psychiatrists there should be more care for potential members. Afterall we should be far more aware than most of the toll constant stress puts on people, and help these individuals address why they are not getting through. Of all the bodies to ignore the consequences of failing these exams it is ironic that it should be the R.C. of Psychiatrists. Then they wonder why they have problems with retention of doctors!

Why not make it mandatory for tutors to have to set time aside to help trainees who are struggling to get through exams. To appraise where their weakness is and how they may address it. It seems to me a simple offer of help may go a long way.

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:'( the australasian exam is an exit exam so you do not have to waste another 3-5 yrs trying to obtain a meaningless ccst.Most Spr's in scotland are not supervised do not attend training,the research is pathetic,usually questionnaire based.

The real difficulty is finding out what knowledge is required and why do they have a cut off at 42--46% when there are 150 consultant posts vacant. :-X

Surely one should be able to pass the written based on 60-70 % pass mark as opposed to competing with your peers. :(. critical appraisal,look at the quality of the yellow peril articles,no wonder the college feels guilty :-[

again the attempts to make the clinicals more fairer is pathetic,see the recent bulletin article by Mcreadie; the psychotherapy PMP has no psychotherapy issues at all. :-*Bias esp racial cannot be eliminated.the way forward is local training scheme based assement with yearly curriculum based theory exams which is not peer referenced

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In Canada teh clinical examination or the IPA is conducted in a very fair manner. Both the examiners and the candidates don't know the background of the patient before the start of the examination and hence the validity and reliablity of the examination is then tested. How two people - one the examiner and the other the candidate look at the patient and evaluate and manage the patient. The candidates are observed while they are conducting the initial examination - one hour type and then discussion is done. So there is no chance that the patient would change the story in front of the examiner.

Plus the examination is videorecorded so that the credibility of the examination is fruther enhanced.

There are only two parts. Part 1 consists of MCQ paper of about 650 MCQ and once passed then candidate can sit in the clinical examination which is Part 2 . No Essay, no critical appraisal, no difficult basic sciences MCQS like monkeys and baboons and all are practical questions which are directly related to the clinical competence of the candidate. The candidate has three attempts at clinical examination and if he is not able to pass at three attempts he has to sit in the MCQ paper again.

So I think what Royal College of Psychiatrists is doing to us is nothing but waste of time.

Dr Hussain

Ireland

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i agree with child psych

like in canada even in USA there is no special exam to be a consultant because the postgraduate training schems are organised in such a way that when the trainee finishes 3 or 4 yeears( i am not sure exactly) they become a chief resident for a year(like spR) before becoming a consultant(they call attendin physician) no exams at all !!!!!!!!!!! they have in house appraisal methods and i believe if the supervising triner is not happy with a trainees progress he can ask thew trinee to reapeat a particular PG year which sonds fair

there is AB exam if you want to take no compulsion and only diffrence they make in in academid jobs where the employers preferred Board certified candidates but the regular run in the mill psychiatrists are all board eligible and also the final clincher !!!! generaally when the finish the training they can do the AB without any problem because exam format is user friendly

i am too old to go to USA otherwise i will be on the next plane to USA and i could not be bothered to go through USMLE etc.

santhana

(A very jealous and stressed partII candidate who has lot of mates in the USA in psychiatry trainnig)

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I agree with the last 2 messages but there are few salient differences to training in the USA. Firstly itis a pyramidal system in that you have to establish the credentials to move on to the next year or repeat or leave the system. Secondly they make sure you slog during the residency programme working at least 12 hours daily, long weekends on call, considerably less annual and study leave(Could you do that here with the EWTD?) Because the training is rigorous they can then afford to practice as board eligible or board certified.

You can imagine the value of MRCPsych eligible vs MRCPsych qualified!

8)

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all exam systems are unfair, but i feel there has to be an exam to ensure people have some form of knowledge. my problem with mrcpsych is that a lot of the stuff examined seems irrelevant.

as for us system vs uk..... the uk system should produce a better quality of psychiatrist.....?

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I don't think exams are indispensable at all! I would agree with some of you above that a competency based exercise needs to take place at some stage after a number of years training and also every few years thereafter. That ensures that trainee competency is examined by competent, up to date others- be it specific examiners, college tutors, patient representatives or others whose interest we serve.

I've seen some of the laziest doctors pass these exams with so much ease. They often careless about their patients but know their books well (you never see them on the wards except when-and if, specifically bleeped) and know how to coduct interviews and impress examiners. College tutors normally would know these people but they don't have much say. Nor can they support good and hardworking candidates within the current system!

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