There are probably good reasons medical colleges don’t give individualised feedback on expensive, high-stakes fellowship exams. But those reasons aren’t easy to come by.
After years of complaints, doctors in training may finally see action on medical college examination policies following new discussions led by the AMA’s registrar council at a recent forum.
Registrars across all specialties have consistently brought up exam feedback – or lack thereof – as an issue in AHPRA’s yearly Medical Training Survey.
According to the most recent survey, two in five specialist registrars disagreed or strongly disagreed that their college exam feedback was useful and one in three disagreed that it was timely.
“That [figure] has been pretty consistent year on year,” AMA council of doctors-in-training chair Dr Sanjay Hettige told The Medical Republic.
“It’s something that the Australian Medical Council knows about as well – it is looking to update its standards related to colleges, and that process is underway.”
Taken on their own, GP trainees were slightly more satisfied than the average doctor – but 32% still disagreed that their exam feedback was useful.
Not only are college exams high stakes from a career perspective, they’re also a big investment.
GPs-in-training with the RACGP pay $2555 a pop for the Applied Knowledge Test and the Key Feature Problem, as well as $5225 for the Clinical Competency exam.
Registrars with ACRRM pay $1795 for a multi-choice exam, $2125 for the Case Based Discussion, $3595 for the Structured Assessment using Multiple Patient Scenarios and $3310 for projects.
Completing the exams across either training college costs more than $10,000 – and that’s assuming one passes every exam on the first try.
“People pay all this money for their exams, and go ‘if I have failed the exam, I don’t want to have to pay all that money again, so can you give me specific ways to pass it?’” Dr Hettige said.
“That question hasn’t been well answered.”
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While he couldn’t speak for all training programs, Dr Hettige said his understanding was that a large chunk of the thousands of dollars paid by registrars per exam went toward venue hire.
“[They need] venues that will be able to hold examinations in the exacting conditions that they’re meant to be [held in], with people supervising – I think that’s a high cost,” he said.
“If examinations are being delivered by computer systems, there’s the cost for those systems and then, if exams are happening in person, the cost of examiners being flown into centres.”
Unfortunately, Dr Hettige said he was light on solutions.
“We do want to provide some feedback to colleges and work with the AMC to change [how they provide exam feedback], but I can’t say that I’ve got any easy fixes in mind,” the registrar said.
“I now know more nuances about what’s going wrong, but I don’t really have any specific solutions or examples of certain colleges doing something really well that we can apply across the board.”
ACRRM president Dr Dan Halliday told TMR that the rural college had focused its energy on trying to prepare candidates for exams.
“Going down to a granular detail [with exam feedback] certainly can be challenging, in so much as going on a line-by-line approach doesn’t necessarily fit with the great body of work that’s been done to assist with the preparation for candidates,” he said.
Several years ago, the college did a root-and-branch overhaul of its multiple patient scenario exam where it focussed on a clearer preparation process.
“I think that if you flip, you can actually say, ‘if we’re preparing our registrars well for the exam process itself, then they’ll have a better understanding of the exam process and the feedback that we do give will be more readily appreciated’,” Dr Halliday said.
Often, exam success rates go down as the number of attempts increase.
The overall pass rate for the RACGP’s most recent KFP exam was 68%.
Broken down by number of attempts, the pass rate was 84% for people on their first attempt, 49% for people on their second attempt, 36% for people on their third attempt and 19% for people on their fourth or subsequent attempt.
