A welcome alternative to the knowledge test

Just the thought of an exam can chill the heart of many a stout soul. Memories of school and university bring on a hint of nausea.

Such thoughts have definitely had an influence when it came to the reaction to the proposals for 'revalidation knowledge tests' espoused first by Dame Janet Smith in her fifth Shipman Review report and then by CMO for England Sir Liam Donaldson in his 'Good Doctors, Safer Patients' paper on medical regulation.

The words knowledge test called up a terrifying spectre of echoing exam halls containing a hundred or so GP peers selected either for their year of qualification or a shared initial. For some, the nightmare vision of Dame Janet or Sir Liam patrolling the aisles with a gimlet eye and a chilling 'sssh' may have featured.

Multiple-choice tests were mentioned. So were tests based on the GMC's objective structural clinical examination used in fitness-to-practise assessments.

Knowledge tests were roundly seen as a 'bad thing'. Not just because of a dislike of exams, rather much of the concern was whether a one-off test every few years really was the best way to measure a GP's abilities.

Some people are good at exams; a couple of hours with an MCQ paper will always garner them a decent pass mark, but does that mean the same person performs well in a consultation or offers high-quality care? The remark that Harold Shipman would probably have aced a knowledge test bears repeating.

Now perhaps the spectre can be exorcised. The RCGP has revealed details of its proposals for how GP knowledge for relicensing should be measured. No exam halls or long tests, but a process of continuing assessment. GPs will be expected to undertake regular continuing professional development modules based, it is assumed, on the college's GP curriculum.

GPs would work through a specific module and then take a mini knowledge test in the comfort of their own homes. Presumably there would be some internet-based element that would allow GP scores and progress to be recorded.

The plan is that the work would take just one hour per week, but continue throughout a GP's career with the results being collated for each round of revalidation.

At face value this would appear a more acceptable approach to government's desire for proof of knowledge. It should also be a supportive process allowing GPs to identify strengths and weaknesses.

The pilots due for later in the year should reveal whether it is also a practical plan.

Whether it would also meet the political objective of stopping another Shipman is a whole other question.

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