Wednesday, 1 October 1997

The Experience of the Patients Taking Part in the MRCPsych Examinations

The Experience of the Patients Taking Part in the MRCPsych Examinations 

This is a draft article on the experience of the patients taking part in the MRCPsych examinations that we will soon republish in a clear format, referencing the original source. This is one of the many other articles I am making available here. The purpose is to find all the evidence regarding the RCPsych Exams and make them accessible to help researchers and students prepare for the MRCPsych Examinations. These articles are already available in journals, particularly the BJPsych Bulletin, albeit in the least-accessible format. We are thankful that the Royal College has published previous print-only articles as scanned PDFs under the Creative Commons license. I am trying to review them, enhance them for clarity and readability, and make them available as text. These adaptations are currently NOT creative-common. We will soon discuss and hope to make them available under a similar license so everyone can benefit by sharing them anywhere.

Darina Sloan, Laura Mannion, Gregory Swanwick, and James O'Boyle

Studies have highlighted Candidates' views regarding examinations in psychiatry in recent years. Few studies to date, however, have examined the views of the patients themselves toward the examination procedure. This study examines the knowledge and experience of a patient group taking part in the College membership examinations. Providing patients with written information prior to the examinations significantly improves their knowledge and experience of the exam procedure.

The participation of patients in the MRCPsych examinations is central to the current format of the clinical exam. Although studies have documented the stressful impact of this experience on the candidate (Williams et al., 1995: Marcus, 1996), and the views of the examiners (Mindham, 1995), researchers have paid little attention to the views of the patients themselves. A study by Persaud et al. (1990) examined the experiences and views of 21 patients who had taken part in the MRCPsych examinations. Prior to taking part in the MRCPsych examinations, the patients had received verbal counseling regarding the purpose and format of the examinations. I interviewed all 21 patients after the examination and questioned them regarding the purpose of the exam, their knowledge of the examination procedure, and their personal views of the experience. The results showed that 29% (n=6) of the patient group found their experience to be distressing. Thirty-eight percent (n=8) of patients said that they would not like to take part in the examinations again in the future. Despite the prior tuition regarding the purpose and format of the examinations, 38% (n=8) of patients failed to recall this information subsequently. Nine percent (n=2) of patients in this study were unaware that participation in the examinations was entirely voluntary. All patients were pleased with the amount of payment received, and most of the group had full recollection regarding details of payment.

Most of the patients viewed the candidate positively, although five (23%) reported that the candidate carried out a physical examination and it surprised them. Interestingly, some patients from this group found the fact that doctors could appear to be nervous rather distressing, although this also allowed them to perceive doctors as being more 'human'. Most of this patient group described their exam experience positively. Persaud et al. (1990) conclude that further, we need research in this area. The purpose of our study was first: to examine patients' experiences during the exam and their Knowledge of the exam procedure and second: to investigate if the provision of written explanatory instructions regarding the examination affected their experiences and knowledge.


Our findings show that taking part in the MRCPsych examinations may be a stressful event for some patients. Despite prior tuition, patient-participants in our study displayed a considerable lack of knowledge about important aspects of the exam procedure, for example, including a physical examination. The study by Persaud et al. (1990) also found deficiencies in patient knowledge, again despite prior briefings. However, their report of overall positive response in the patient group towards exam participation was in keeping with the positive views expressed by our own population.

Sixty-five percent of our verbally prepared group and 31 % of the group whom we had given written preparation, found the examination distressing, as compared to 29% in the Persaud et al. study. Events that patients found to be distressing were, however, comparable in both patient groups. Receipt of written instructions regarding the exam followed a significant reduction in reported levels of anxiety. All candidates in our study said they would be happy to take part in the exams again if asked and finding contrasts with the eight patients (38%) of the sample from the study that Persaud et al. did, who showed that they would not like to take part in the MRCPsych examinations again. Although the College had informed the patients in our study and those in Persaud et al. study on the payment they would receive, it is of interest that no patient group had a universal recollection of this. Patients in both studies thought that the amount of money they received was adequate. Both studies revealed that they viewed the candidates positively and with a certain amount of sympathy. 

The results highlight an area of inquiry that researchers have neglected. However, our study takes this line of inquiry a step further by investigating the effect of a simple intervention, i.e. the provision of written instructions to take part patients on patients' attitudes and knowledge. It would appear to be important to prepare candidates individually for their participation in the examinations.

Many of the events which caused anxiety and distress in both patient groups appeared to have their basis in insufficient Knowledge. Despite prior tuition in exam format, some patients may still forget certain details. We recommend the provision of written instructions, besides the routine assessment of patients' views and experiences following each set of examinations.

Patients contribute importantly to the successful running of the MRCPsych examinations. We feel that any study which examines their views and experiences following participation in the examinations will be of benefit not only to exam organizers but also to taking part candidates in the future.

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