1 June 2021

Syllabus may make amends for failing exam system

Comment RACGP

This year, the RACGP is developing a national vocational training syllabus to better support GPs in training on their journey to fellowship.

Good. We are in dire need of a standardised national curriculum from the college. After all, it does run a standardised national exam that costs each candidate ~$10,000 per cycle, more if a candidate fails and has to repeat.

It would make better sense for said curriculum to have been drafted before the exams, with the same alleged rigour, testing and standardisation – but for esoteric and perhaps fiscal wisdom known only to the college, we now have the exam cart long before the syllabus horse. 

It’s never too late to make amends, dear college. A national syllabus will better support learning and teaching by providing trainees, supervisors and educators with clinical cases, learning guides and resources to direct learning around the RACGP curriculum. A national syllabus will also enable vocational education and training to be consistent in its content and structure across Australia.

It might also mark the demise of the lucrative FRACGP exam preparation industry that focuses more on exam technique than day-to-day clinical acumen.

In similar vein, the RACGP owes every GP registrar and fellow a formal apology for putting them through harrowing fellowship exams, worse if these candidates have had to or are facing resit.

Candidates do not get any individualised feedback on any of their exams, and they do not get access to review their own exam paper. They are simply referred to the public exam reports. This vague feedback is lazy teaching at best; at worst, some cynics assert, it’s designed to take more exam fees from already distraught candidates.

Nor is there any scope for a re-marking of a paper. The process for exam appeal and review officially states: “an investigation will be undertaken to ensure all exam marking and quality assurance steps were correctly executed. This investigation does not extend to a remarking of an examination paper or reassessment of exam performance.”

As the RACGP is a training college, common sense dictates that any candidate who fails should be given personal feedback and access to their paper and the marking key so they might objectively learn from their mistakes – but none of this is allowed by the college. How does this fulfil their duty to teach?

Candidates suffer marginal fails or passes by a thin margin of 0.01 to 2%. Yes: depending on the roll of the RACGP dice, you could pass or fail by that much or that little, yet you are denied information on where you went wrong.

Some exam candidates last year worked at the frontlines of the COVID19 pandemic, then faced the exam IT crash, and had to wrestle an apology from the RACGP, which then let them resit in December.

It is ironic that the CHECK publications sent to fellows for their continuing professional education are deemed insufficient as exam preparation for GPs in training. That’s because these stunted fellowship exams focus on exam technique, which has nothing to do with realistic, day-to-day clinical experience but is about navigating a convoluted English test while trying to read the mind of the examiner.

Hopefully, the standardised national curriculum can agree that what is good enough education for fellows ought to be good enough for fellows-to-be. Perhaps, some basic training duty of care will be discharged. What next? More sensible exams for GPs in training?

The college has not given a clear account of the personal data integrity of the IT crash last year but simply swept it under the carpet, hoping we would forget. To this day, nothing of substance has been said as to the data integrity of the personal details the overseas proctors captured.

The UK and New Zealand don’t have a KFP equivalent for their GPs, who are equally competent. They could even be more competent, since more of their training time can be spent on actual clinical medicine than wasted on learning useless exam technique.

The Australian College of Rural and Remote Medicine has a superior curriculum and its assessments reflect the same pragmatic clinical utility. Given the recent and ongoing failures of the RACGP, many GPs in training would have quickly enrolled with ACCRM but for ACCRM’s refusal. Yes, we explored this option as well writing to the Prime Minister of New Zealand for help …

The RACGP is running focus groups on the new curriculum. The deadline to join was 28 May, but you might as well contact the syllabus program lead, Alanna Kirley on alanna.kirley@racgp.org.au, in case they still have places available.

Hopefully, this new curriculum will help set a standard instead of leaving candidates stranded. 

The authors of this piece are among those whose remote fellowship exams were disrupted last year by the IT failure, and who sought legal redress from the RACGP. Some have failed the RACGP exams several times and still are unable to learn from their mistakes because of the policy that bars failed candidates from reviewing their exam papers and marking keys.

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5 Comments on "Syllabus may make amends for failing exam system"

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Fred Smith
Fred Smith
4 months 25 days ago
1. Dissatisfaction with the KFP has been ongoing for some years – the same problems and complaints, yet less so for the AKT and OSCE/RCE. Why the same issues year in and year out for the same exam and not with the other two exams? The answer is lengthy, but we would all agreed the they main exam of concern is, repeatedly, the KFP. I wonder if anyone has bothered to take note? 2. There is an uncoupling or disconnect between training/curriculum and the exams, particularly with the KFP exam. The KFP is an odd exam with a particular style… Read more »
John Smith
John Smith
4 months 19 days ago

Fred Smith, you seem to have intimate knowledge of the inner workings of the exam process. Are you willing to discuss further? It is definitely long overdue for an independent, formal inquiry to address these matters.

Dr Katie Williamson
Dr Katie Williamson
4 months 25 days ago

As a medical educator, I am privileged to help Registrars develop their clinical reasoning skills. While the KFP may not be the perfect exam, and I think we are yet to find one, I have observed it to differentiate between the high and low-performing candidates regarding clinical reasoning. When we can talk a pass-Registrar and a fail-Registrar through a KFP question, you can see the difference, and “exam technique” is a very small part.

4 months 26 days ago
So you’re letting failed exam candidates vent their spleen about the exams they’ve failed … and somehow, this is supposed to be newsworthy? Please! How is this either (a) insightful, or (b) unbiased? Of course the exam candidates who have failed multiple times will think it’s the exam’s fault. What about all of the other candidates who passed? What do they think? They probably don’t have any problem with the exam. Also, how can we get an intelligent discussion about the correlation of the curriculum and the success of an exam from the failed candidates? How about asking the people… Read more »
Penny Durham
4 months 25 days ago
Dear Anonymous, This is a comment piece and is clearly labelled so, and makes no claim to be an unbiased news report. We don’t see having failed an exam as a disqualification from having an opinion on that experience. We think failing a career-determining exam by a sliver of a mark and never knowing what you got wrong, given what it costs you in time, effort and money – 10x more so if you didn’t grow up here – is unjust and is not in the best interests of training. And we can only hope your attitude is not representative… Read more »