Exclusive: RCGP could allow GP trainees extra chance to pass CSA test

GP trainees could be handed an extra chance to pass parts of MRCGP exams, after the RCGP said it was 'receptive in principle' to a rethink on the existing four-attempt limit.

RCGP headquarters: exam limit could be revised
RCGP headquarters: exam limit could be revised

The RCGP told GPonline it was open to the change after claims earlier this week from the British Association of Physicians of Indian Origin (BAPIO) that hundreds of highly qualified would-be GPs were being 'locked out' of the profession.

BAPIO president Dr Ramesh Mehta warned that potential GPs were being lost to the NHS because some doctors who had successfully completed much of their training struggled with the clinical skills assessment (CSA) element of MRCGP exams. The current cap of four attempts at passing the test meant that people who had failed were then prevented from ever taking up a career in general practice, he said.

RCGP chief examiner Dr Pauline Foreman said: 'The current regulations for candidates who entered UK GP specialty training after 1 August 2010 permit a maximum of four attempts at both the applied knowledge test (AKT) and CSA during training.

GP exam limit

'This limitation on the number of attempts is evidence based, and the current policy has been approved by the GMC. Analysis of examination data suggests that after four attempts at either the AKT or CSA a point is reached where further attempts at an examination are unlikely to be successful except by chance, and this has implications both for candidates and potentially for patient safety.'

Fifth attempts should 'therefore always be in exceptional circumstances', Dr Foreman said.

But she added: 'The RCGP would be receptive in principle to a change to the current regulations to allow an exceptional fifth attempt at either the AKT or CSA provided that those sitting for a fifth time have undertaken appropriate additional educational experience since their last examination failure and sufficient progress has been made to merit a further attempt. Any arrangements of this kind would of course need to be agreed collaboratively with the deaneries/LETBs as they are the bodies responsible for GP training, and the RCGP is currently working towards this aim.'

Last year the RCGP successfully defended itself against a legal challenge brought by BAPIO, which claimed that the CSA test was racially discriminatory. BAPIO chose to take legal action after data showed that UK graduates from black and minority ethnic backgrounds were four times as likely to fail the CSA test as their white counterparts.

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