Tuesday, 12 January 2021

Final MRCPsych Examinations Need to be Rigorous (Davies et. al)

Final MRCPsych Examinations must be Rigorous

The Royal College accepts you into the Psychiatry Training Program in the UK when you have passed all three parts of the MRCPsych Examinations and have two years of experience of work in psychiatry. So, the final or the exit exam serves as a selection-criterion. Davis et al. has criticized and suggested changes to the system.
  • Measuring trainees' competence before considering them competent to practice in an unsupervised and leadership role is eminently reasonable
  • We should understand that such an examination should essentially be a measure of the training program rather than the individual competence of the trainee
  • Not that the competence of the trainee is not important, but that the exit examination should not function as a selection criterion.
  • It is not fair to allow a trainee who does not have the potential competence to successfully work as a consultant—and this would seem to involve clinical and communication skills—to devote fruitless years to training.
  • Candidates considered suitable initially may at a later stage show problems that prevent a successful transition to a consultant career
  • I would note that the reliability quoted by Burn & Bowie represents a correlation between test items and apart from assuming that the results represent interval, rather than ordinal-data, says nothing about the validity
As a former member of the Association of Psychiatrists in Training, which was founded to support the changes involved in the new College structure, I would like to comment on the paper by Hughes and colleagues1 and the issues raised by Shields.

Measuring trainees' competence before considering them competent to practice in an unsupervised and leadership role is eminently reasonable. However, it should be understood that such an examination should essentially be a measure of the training program rather than the individual competence of the trainee. Not that the competence of the trainee is not important, but that the exit examination should not function as a selection criterion. It is simply not fair to allow a trainee who does not have the potential competence to successfully work as a consultant—and this would seem to particularly involve clinical and communication skills—to devote fruitless years to training. For various reasons, candidates considered suitable initially may at a later stage show problems that prevent a successful transition to a consultant career. The main selection point should be early enough to allow those regarded as less suitable to pursue alternative areas of medicine for which they may be better fitted.

Thus, while the final examinations should be rigorous, they should focus on more specific areas of knowledge and the expected pass rate of properly trained candidates should be very high. I would also note that the reliability quoted by Burn & Bowie simply represents a correlation between test items and apart from assuming that the results represent interval, rather than ordinal data, says nothing about validity.

References
1. Hughes NS, Haselgrove A, Tovey MS, Khokhar WA, Husain M, Osman-Hicks VC. Exit examination: a survey of UK psychiatrists' views. BJPsych Bull 2015; 39: 254-9.
2. Shields GS. Raising the standard: it's time to review the MRCPsych examinations. BJPsych Bull 2015; 39: 262 
3. Burn W, Bowie P. Raising the standard: it's time to review the MRCPsych examinations. The Royal College of Psychiatrists' response. BJPsych Bull 2015; 39: 262-3.
Source
Davies GR. The exit examination should not function as a selection criterion. BJPsych Bull. 2016;40(1):49. doi:10.1192/pb.40.1.49

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