One in three GPs say trainees should have more than four CSA attempts

Almost a third of GPs believe that the four-attempt limit trainees are allowed at the CSA exam should slackened or abolished completely, a GPonline survey has revealed.

Dr Krishna Kasaraneni: ‘If you offer unlimited attempts, the reliability of the assessment comes into question’ (Photo: JH Lancy)
Dr Krishna Kasaraneni: ‘If you offer unlimited attempts, the reliability of the assessment comes into question’ (Photo: JH Lancy)

Some 30% of GPs said that trainees should be allowed more than four chances to pass the CSA, after GPonline revealed hundreds of potential GPs are being locked out of working in general practice because of strict limits.

The GPC warned that extending the limit on attempts may not be the answer, but added it was looking into ways to break down barriers to general practice arising because of the exam.

Current restrictions allow hopeful GPs a maximum of four attempts to take the CSA component of MRCGP exams. If a candidate fails to pass within the allotted limit they are then barred from working in UK general practice.

According to the GPonline poll, over half (56%) of GPs think that the four-attempt threshold should remain unchanged. However, 17% called for the limit to be ‘abolished altogether’ and a further 13% believe that trainees should be allowed more attempts.

A further 14% think that the limits are not stringent enough and the number of attempts should be made even smaller.

GP workforce problems

The results come after the British Association of Physicians of Indian Origin (BAPIO) warned that hundreds of fully-trained aspirant GPs were being locked out of the profession because of the limits.

The RCGP has since told GPonline that it was ‘receptive in principle’ to a rethink on the imposed limits.

One GP responding to the survey said it was ‘unfair to call time out’ on unsuccessful trainees, and it should be their decision on whether they wish to take more attempts or bow out. Another said the exam should not work to penalise ‘nervous characters’.

But many said allowing more attempts could put the integrity of the test into question. ‘Passing on the fifth attempt has been shown t occur by chance, which is not reassuring for the safety of our patients.’

Dr Krishna Kasaraneni, chairman of the GPC's education, training and workforce subcommittee, warned that changing the limits on exams was not necessarily the way forward. ‘If you offer unlimited attempts, the reliability of the assessment comes into question,’ he said.

‘I think we should take it back to step one: if someone has been selected correctly for their training programme and they have been trained correctly throughout, then they should pass the exam relatively easily.

‘If somebody is repeatedly failing, we need to flag that up so they can be given extra support to get them through, rather than merely providing more and more opportunities.

‘There is an emotional aspect where if someone doesn’t get through this assessment – essentially, their general practice career in the UK is finished because there aren’t other jobs in general practice that these people can go into. That certainly merits further discussion, and from the GPC's point of view that is something we want to look at.’

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