On 19 March 2020, the GP Clinical Skills Assessment exam (CSA) was cancelled by the Royal College of General Practitioners until further notice as a result of the covid-19 crisis. The CSA exam is an ideal breeding ground for virus transmission. Each sitting simulates a typical GP clinic. There are 13 stations with an actor and an examiner and three circuits are run simultaneously meaning there are well over 100 people involved with each sitting. The exam is only held in London at the RCGP headquarters and all the examiners are GPs. It’s amazing to think that any sittings took place in March at all and it was right that the exam was suspended.
The RCGP explained that the examination would be carried forward to a rescheduled sitting, “at a time when we can run them safely and reliably.” What many trainees had hoped was that the RCGP would instead look at the nearly three years of training and assessments they had already done and allow those who were on track to pass, to qualify as fully trained GPs, particularly at this time of national crisis. Sadly, this has not been the case. 1500 final year GP trainees, who expected to be fully qualified GPs in August are now in limbo.
We’ve heard rumours that the RCGP might create a new status for these trainees allowing less supervision and potentially deploying them to other GP practices where they can have “remote supervision.” This would mean GP supervisors are going to be in short supply as the new final year of GP trainees take up their GP surgery posts in August. GP supervisors might then have to look after more than one trainee at a time, adding more work to their day. This could be the plan while we wait until it’s safe for over 100 people at a time from all over the country to come together in London. Until then, anyone still considered to be a trainee will need supervision for all the clinical sessions they do and for any out-of-hours work.
The CSA has met with controversy before. Introduced in 2007, it has been criticised for discriminating against non- white doctors and those who went to medical school abroad. In these groups the pass mark is notably lower. The RCGP and GMC have faced court action for unlawful discrimination in the CSA. Although in 2014 the courts ruled that the examination was lawful, the court could not deny that the exam showed was biased against non-white candidates and called for reform. With calls to use the covid-19 pandemic as an opportunity to address health inequalities, is this not also the moment to think about reforming an assessment that is certainly not equal to all that sit it?
It’s also worth mentioning that the numbers who fail the exam are tiny. On average, 97% of candidates pass, a figure almost unheard of in medical exams and there have been calls to scrap it for this reason alone. We already have a GP entrance exam, and are assessed through “work based assessments” throughout training. Many would argue this is enough.
Medical schools have shown impressive flexibility in allowing their students to graduate as doctors without sitting their final year exams. Retired GPs have been allowed to return to practice and are exempt from reappraisal and revalidation. Schools too have changed with the times, awarding students A levels and GCSEs based on their prior performance.
We receive regular emails from the RCGP about the need to adapt at pace to the current crisis, how grateful they are for the work we are doing on the front line and that they appreciate the extra risk we are taking on. Should the RCGP and GMC not show some of this adaptability too?
As a group of trainees in Lewisham we have written to the RCGP and the GMC to ask them to consider allowing the 1500 affected doctors to be allowed to become fully qualified GPs in August. The RCGP have said they are still in discussions with the GMC, Health Education England, and others and that they will do their “utmost to ensure everyone has the same opportunities to sit the CSA.” We await the GMC’s reply.
For now it looks like there will be 1500 fewer GPs than expected in August, a disaster in a pandemic
Jessie Colquhoun is an ST3 GP trainee in Lewisham and Greenwich NHS trust and former editor of BMJ Student. Twitter: @dr_on_a_bicycle
Competing interests: None declared