The Members of the Council
Royal College of Psychiatrists
17 Belgrave Square
London
SW1 7PZ
Dear Members of the Council
Ref: Expiry of MRCPsych part 1 and the plight of the affected candidates
I wish to apprise you of the plight of the candidates who are going to be adversely affected by the expiry of MRCPsych part 1.
I attended a meeting on this matter in the College convened to listen to the views of these candidates on 9th July 2010, attended by the President, the Chief Executive and Mr Palekar from the Exams department.
In brief, I believe this matter deserves immediate attention of the College Council, as some unfair and unjust decisions were made, which are adversely affecting the careers and lives of more than two hundred candidates, who are mainly psychiatric trainees and some SAS doctors.
On the surface it may appear to an onlooker (as it happened to me initially) that this is a grievance from a group of disgruntled candidates, mainly from overseas, who are unable to clear the exam in time given by the College. But a closer examination reveals that the matter is much more complex and that there is an inherent unfairness in this matter, disproportionately so towards female candidates.
I had a chance to consider the issues raised by the candidates at some depth. I will set out those in some detail below based on the facts and opinions gathered from the delegation, which met the President, and the Chief Executive on 9th July 2010. I am thus bringing to your attention a profoundly serious matter that requires your urgent intervention with the retrospective invalidation of the part 1 of the MRCPsych examination.
As I understand the matters, under the old system, Royal College of Psychiatrists' exams were divided into Parts 1 and 2. Each part had a written and a clinical component. But, in 2008, College changed the exams to three written papers followed by a Clinical Assessment of Skills and Competencies examination (CASC). In this system, a pass in paper 1 and 2 will be banked forever. However, after passing paper 3 of the examination a candidate had four chances at CASC. If the candidate failed to pass the examination within an allocated timeframe, She or he was expected to re-sit paper 3 and then repeat the cycle.
In the changed or revised examination process the college announced validity period retrospectively, for those who held a pass in Part I of the previous format. The College decided that a pass in Part I would expire and not count towards completing the membership exams, after July 2010.
The trainees were not informed that this could be the case when they originally sat for their Part 1 and OSCE examination. The regulations of the previous format of the examination did not state a number of attempts or period of validity.
Those candidates who had passed Part 1 than took OSCE exam, which obviously needed a lot of preparation and competence. It seems to me that as this is now discarded the above candidates were seriously disadvantaged by the above decision. Ironically, the examination committee decided that in the future a pass in the current papers 1 and 2 would remain permanent in the new system.
The trainees have told me that they feel 'cheated and abused at the hands of their own college'. They lamented that they have been made to feel that they have wasted their time and money. The manner in which the change is being managed has been making the trainees feel less valued as their hard earned part 1 examination results are totally discredited by the same organisation which awarded it with out any prospective conditions. Indeed, there is a growing anger and feelings of dejection and hopelessness in these trainees. Many of them may give up training or change the speciality, which will seriously deprive not only the workforce of trained psychiatrists but would be a waste of energy and financial investment done both by the NHS and trainees. The College must not underestimate their anger and sense of dejection among this group.
It seems to me that this is a grave injustice and against the College's own principles of fairness and inclusiveness. The College rests its case on two issues - firstly the matter of different curriculums and methods of assessment for the part 1 and paper 1 & 2 and secondly the issue of public safety due to 'poorly' or 'incompletely' trained doctors slipping through the net.
My response to the first issue is that the EMI, ISQ & OSCE type methods for assessments are very well established. These methods were used to assess candidates for Part 1. The College's curriculum for part 1 is essentially the same as paper 1 and paper 2 with notable exception of the part on genetics, which was not formally tested in old part 1 and the fact that OSCEs are not currently used in the new paper 1 & 2 format. The college reserves the right to vary the proportion of areas in which to assess the candidates and I believe that genetics was not a major contributor to paper 2 exams recently as well. Secondly, the reason to change the exam structure to the current modular format was not due to the 'invalid and unreliable' methods of assessment of the old part 1, but it was the non standardized mode of assessment through PMP, Essay writing and in particular the long case, which was a major source of concern for the College and the PMETB and eventually led to the scrapping of this method of assessment.
The College's second point is offending to the trainees whom I have met and they feel it represents aloofness, and lack of fair and sympathetic attitude towards its trainees. I agree with trainees the agencies the GMC, PMETB and the employers themselves have the responsibility to ensure that doctors have the knowledge and competencies to progress through measures like WPBAs, ARCP, Annual NHS appraisal, 360 degrees appraisals and CPD (led by the College), which trainees and SAS psychiatrists are expected to undertake to ensure so that they can be trusted by the public and continue to have knowledge and competencies in their chosen area of practice. The College does have a role in the process but not the sole responsibility and that too not entirely through exams. Besides these are well establishes supervision processes in the NHS aimed at safety of the patients. Liking patient safety to the issue of Part 1 expiry does not have a convincing basis. Also where does this logic stand when you apply the same analogy to the indefinite validity of the current Paper 1 and Paper 2.
The inflexibility shown by College is likely to contribute towards the recruitment and retention problems in psychiatry. The NHS Trusts are spending huge amounts of money on appointing locums to run the services at the moment and at the same time trainees willing to be trained further are inappropriately ignored in the name of 'maintaining standards for the public safety'.
No doubt there are always two interpretations of these decisions but I cannot fail to appreciate the concerns of these young doctors who feel contradictions in College's position in dealing with the part 1. They highlight the fact that they were not told at the time when they took part 1 that it could be invalid one day. They were not communicated this decision in any form by the College. They have told me that it makes no sense that when Paper 1 & 2, which are part 1 equivalent in the new system can be banked 'permanently''; but it is not right the other way round. It does not make sense to them as to how the changes after the 31st July 2010, given the above arguments, will lead to more competent and safe doctors. I can sympathize with them when all they want is College respecting its regulations when the trainees took their exams.
As I gather the trainees do not want any deadlock and are happy for the College to look at the previous precedents set up by its own committees whilst dealing with issues in the past. These include reversing the decision on a permanent fail in the preliminary examination in the late 80s. The college continued to allow people to take part 2 even if they had passed their part 1 up to 20 years ago, e.g. a person who had passed part 1 in 1987 (following the change in permanent fail system) could have continued to attempt part 2 until 2007. How can one justify the current decision to disqualify Part 1 exam with in 4 years of passing it (at least in some cases)? I was also been told that most of the affected candidates passed their part 1 between 2006 and 2008.
They also want that a common invalidity period is not placed on all the candidates and they believe that in the past College has shown flexibility and pragmatism on matters like these. It seems they are right in pleading to the College that consideration be shown about part time trainees and people who took breaks to raise a family and other valid personal commitments. It appears this invalidity period also coincided with upheavals in many trainees' lives due to the MMC and MTAS fiascos.
The three year deadline set up by our College in this matter seems to be at huge variance with the practice of other large Royal Colleges (of Surgeons and of Physicians) in similar situations. This hardly gave only one attempt to sit for the exam in some cases. In the past the College had extended the validity of its own previous examinations up to a period of eight years. This is a standard practice for other medical and surgical royal colleges currently and is also based on evidence for validity of examinations from America. The Royal College of Surgeons expect people to pass all the exams within 3.5 years from the date of pass of the first exam. The RCS proposed a change in their system of examination only after consultation with many stake holders and has shown much more flexibility. For example currently there are two parallel systems of exams are run by the RCS. Candidates can chose either system and can also switch between systems. This has been happening since 2004 and is due to end in 2010.
I believe the College should not discriminate trainees who passed their exams at different times to set up a common invalidity period. This is particularly true for people who had by the start of 2008, after having passed their part 1 in 2006, not achieved the recommended 30 months training period to have taken part 2; particularly so when started to publicise the change in system only in March 2007.
I believe this group of candidates are setup to become victims of the change, which they believe has not been managed fairly by the College. I believe, irrespective of the outcome of the matter, it is the College Council, which should have a final say on the matter as the ultimate decision making body of the College; particularly so as the reputation of the College is at stake.
Dr Seshagiri Rao Nimmagadda
Elected Member of the College Council
Former Chair of Collegiate Trainees' Committee