That exam failure stone the RACGP never quite got around to turning over

After last year's big technical glitch, a superspreader event would have been less than ideal.

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Yesterday, one bright and bushy-tailed KFP exam-bound registrar got himself up early so he would be able to get to his exam at Sydney’s International Convention Centre, at the heart of the city in Darling Harbour, with plenty of time to spare.

He had a long way to travel from the outer reaches of greater Sydney and wanted to make sure nothing went wrong. You might imagine he was thinking that there being a pandemic and a lockdown and all, being extra prepared wasn’t a bad strategy.

Being that way,  just before he went out his front door, he thought he’d check his emails just to be safe: and there he found this communication from his examiners at 9.19am,  just a few hours before he was due at the venue.

I wonder what our readers would have thought, if put in the shoes of this registrar?

What if you are a registrar who has to pick up your kids at 6pm from childcare, is a single mum, or is working from 6pm already?

You can imagine that a notice like this, this late, would easily be a major stress-initiating factor for a significant number of registrars.

Clearly the failure of last year’s online exam series for something like 1200 students across the country represents some serious scar tissue for the college that they’d like not to see as an open wound again.

So, in some ways you can see why it had persisted, amid an ever-worsening lockdown in Sydney, with the idea that they could still hold the exam in person in the city.

And they got away with it – no positive tests and only an hour’s delay. Good result.

But why, after such significant failure last year, so many promises to leave “no stone unturned” in fixing up that disaster, and a pretty obvious continuing threat of a covid lockdown that was worsening (and what that could easily do to a live exam with 250 people coming from all over a panicked locked-down city to sit), was there no plan B?

If you read this last minute communication to registrars, the college was clearly at a desperate point. A bomb was about to go off around them and they were laying the ground for damage control. They diffused the bomb mostly but that they got themselves into such a position is pretty telling and a worry.

While the college must have wanted to push ahead to lessen the stress on their registrars, as a postponement would be stressful, why hadn’t it already war gamed much more severe lockdown restrictions and what it would do if it had to cancel last minute?

Should we simply blame NSW Health for requiring at the very last minute that every student be PCR tested prior to sitting the exam, instead of having to sign off what was effectively a form of stat dec by each student prior saying they hadn’t been exposed and weren’t positive, which was all the students thought they had to do until 9.19am yesterday?

It’s hard to rationalise why either NSW Health or the college thought it would be OK to have the exams based on just a signed form from each student.

The cohort is operating all over Sydney, and presumably a good number are working in practices at the front line where you’d have to assume they are at a much higher risk of contracting covid than a citizen in lockdown.

That risk could be significantly heightened if a student was working in one of the many Western Sydney hotspots (which we know some have been) and that, being students, they are probably less likely to be vaccinated than their GP bosses in the practices.

So, demanding a PCR test before everyone goes into a room and creating a possible superspreader event is sensible.

But demanding it –  making it compulsory – three hours before you sit an exam?

And then saying to your cohort, many of whom would not have even read the communication before arriving at the venue:

• You might be here for up to nine-or-so hours, not 4-5
• You’ll be locked down inside the venue for that time
• BYO everything to keep yourself healthy, not hungry and safe for that time
• You’ll be taking a compulsory PCR test and have to wait a couple of hours at least, maybe up to three hours, before you start the exam …

NSW Health requesting a PCR test for all students prior to exam is not great. But sitting the exam under the circumstances with only a form of acknowledgement from each student that they didn’t think they would have covid was probably crazy.

What if a student did sit the exam infected, not knowing as they were asymptomatic and had not been tested, when they filled out their form, and we ended up dispersing 250 registrars back to work in 200 or so GP practices with a select number infected?

What would happen to the image of general practice if it got out that the college had sparked a new superspreader episode? The stakes here are obviously very high for all parties and the college has through past failure put a lot of pressure on itself to get things right when during a pandemic things tend to go to crap pretty randomly.

Could the college cry foul at the last-minute antics of a state government? Is erratic and last-minute state or federal government decision making not something they wouldn’t war game in their planning to protect their students after last year?

No student at the KFP tested positive yesterday (Friday) but what if a student had, and what if a student tests positive at the AKT today (Saturday)?

How accurate can this new point-of-care PCR test be that you’d put this much trust in it?

It hasn’t been used to date because of how inaccurate it is seen to be.

And why there no plan B or C here?

They had a lucky outcome today, and avoided the extra trauma that cancellation would have put on trainees – but this is RACGP core business and it should not have come down to the wire like this.

Here are some excerpts from a piece the president of the college, Dr Karen Price, wrote in Medical Observer, just a couple of months after the exam debacle of last year, and just a month before she assumed her role officially in November.

The title of her article –  ‘Healing exam trauma will form a pivotal part of my presidency’ –  sort of gives away what the college might be getting wrong here:

“It is essential that the exam failure is not whitewashed but is dealt with transparently and becomes an impetus for change, specifically the progression of member-led value at the college.

“This requires the college to leave no stone unturned. Lives were severely disrupted. We know there is no easy path to qualify as a medical specialist. It often requires individuals to deal with great challenges through significant major life events.

“While it is a sacrifice for which our candidates are prepared, they equally have a right to expect that they will not confront unnecessary and artificial hurdles.

“Getting it right, especially during this pandemic, is vital.”

Getting it right during a pandemic wasn’t just vital for the RACGP after last year, it was first base in a big journey to restore some credibility and trust with its registrar base. Hence, I guess, why Dr Price stuck her neck out. She couldn’t really do anything less.

But having stuck it out that far, it’s hard to see how the college could explain what has happened this week at the ICC in its KFP and AKT exams. They might say it turned out OK. But that would miss the point. They had no plan B and they were very close to a big blow up.

They surely aren’t going to go the resilience line: in a pandemic we all have to put up with some restrictions and hardship for the greater good. Or, yes, there was some trauma here, but not as much as last time, and there is a pandemic.

Probably not good enough.

Of course, we have to give in a pandemic. But not when a bit of basic preparation means you don’t have to, and not when you’ve already caused so much trauma you can’t afford an ounce more.

What preparation?

Getting its act together on being able to conduct these exams online properly.

It’s not like the RACGP has a unique problem to solve: conducting online exams at scale with appropriate oversight, technology and privacy in place.

We have any number of giant learning institutions in the country that have solved the problem a long time ago.

And it’s not as though the RACGP didn’t have the money to fix the problem, the time to fix the problem or that the problem is some sort of technology pipe dream. It is actually pretty basic, tech wise.

The default to pen and paper was an understandable and sensible initial fallback. But in a pandemic, not looking at where you went wrong and developing a workable online exam option feels almost negligent given what happened last year.

Not to have that problem sorted after 10 months is a pretty serious issue for the board and for the executive, and one which all of the members should be worrying about.