Dr Ahmed Hashim highlights the dilemma of the restrictions imposed on candidates from Sudan sitting for Royal College exams…
Virtually no aspect of clinical practice has been spared from striking disruptions caused by the COVID-19 pandemic. In addition to the necessity of reorganising how clinical services are delivered, the pandemic has introduced many complexities in terms of providing teaching programmes, delivering training schemes, holding exams and assessments, and organising conferences; all of which have been redesigned due to our attempts to meticulously adhere to social distancing measures and avoid public gatherings.
Postgraduate exams were not spared, and most Royal College exams were cancelled at short notice at the beginning of the pandemic’s first wave . After a period of uncertainty, these exams were reinstated with new arrangements and the employment of online invigilation systems [1, 2]. The remote proctoring technique aims to reintroduce the examination hall experience in an online setting, providing candidates with the option to sit for the exam at a location of their choosing, including at home, at work, or at a dedicated testing centre [2,3,4]. Pearson Vue, together with its online proctoring system (OnVue), is currently one of the most commonly used platforms and has been implemented for a sizeable number of the Royal College exams. Debates and deliberations regarding the applicability of these online monitoring strategies are currently ongoing, and one recent controversy introduced the potential for privacy invasion. University students in Australia have criticised and rejected the online monitoring of exams through software operated by third-party companies due to privacy concerns .
However, a different dilemma has been encountered by Sudanese doctors, who have been significantly disadvantaged by the embargo and economic sanctions imposed by the US government on Sudan, preventing access to online examination software [6, 7]. This predicament came to light in the middle of last year because the Royal College of Emergency Medicine (RCEM) exams started to be administered using the Pearson Vue system. The use of the Pearson Vue system by several Royal Colleges has resulted in some Sudanese candidates being unable to sit for the majority of Royal College exams. The Pearson Vue website and examination portal are subject to the US embargo against Sudan, and even candidates who have attempted to travel abroad to sit for these exams have been denied entry to Pearson Vue centres in host countries, because identification documents issued by the government of Sudan have been rejected . Other countries, such as Syria [7, 8] appear to be affected by similar sanctions, and candidates from these countries have most likely faced similar challenges.
Historically, the Sudanese postgraduate training system has been intricately linked to the British system, starting with the introduction of formal medical education in Sudan in the 1920s, during the British colonial era . The Royal College exams in Sudan are widely accepted as alternatives to local exams, and the UK has long been among the top destinations for Sudanese graduates who are willing to undertake their postgraduate training abroad . Despite proposals to assign a dedicated centre in the capital city of Khartoum to host Royal College exams, similar to existing units run by the British Council, these recommendations have not yet been implemented.
Under the current circumstances, candidates from Sudan remain barred from most Royal College online exams unless they can present identification documents issued by another, ‘unsanctioned’ country. Many Sudanese doctors categorically view this disappointing and unfair situation as an educational bias that has unfortunately been inflicted upon them due to political conditions.
Although the Royal Colleges have clearly and understandably stated that this unforeseen predicament does not represent their values; the current exclusion continues, and defies the ethos shared by the Royal Colleges regarding inclusiveness and diversity, and risks jeopardising the international strategies that have been adopted by these institutions to raise the global standards of training and assessment.
In a positive development, the US sanctions against Sudan were officially lifted in December of last year, paving the way for such obstacles to be abolished . However, it is still unclear whether restrictions placed on online examination software will be removed immediately, and whether these measures will be enacted in time to allow Sudanese candidates to sit for exams in 2021.
The struggle faced by Sudanese doctors in this matter risks being seen as a malign example of political infringement on medical education in developing countries, and on medical healthcare standards. Whilst there is evident and understandable complexity in navigating the political landscape, the Royal Colleges must have a duty to remain cognisant of these socio-political hurdles, and to the risks of educational exclusion to the doctors and healthcare systems in these already disadvantaged regions. It is unclear what contract responsibilities the colleges have towards online platforms, but any of these complexities should be of secondary consideration to the needs of medical education, and the crucial and continuing role of the Royal Colleges in maintaining their reputation and international standing. As for the present case, urgent attention and joint efforts coordinated by the Academy of Medical Royal Colleges remain necessary to resolve the plight of Sudanese candidates who are currently facing this online examination dilemma.
- Exams for doctors in training. Academy of Medical Royal Colleges, COPMED and GMC statement. March 2020. https://www.aomrc.org.uk/statements/academy-copmed-gmcstatement-exams-for-doctors-in-training-covid-19/
- 2- Gerrard Phillips, Mike Jones, Ken Dagg. Restarting training and examinations in the era of COVID-19: a perspective from the Federation of Royal Colleges of Physicians UK. Clinical Medicine Nov 2020, 20 (6) e248-e252; DOI: 10.7861/clinmed.2020-0481
- Butler-Henderson K, Crawford J. A systematic review of online examinations: A pedagogical innovation for scalable authentication and integrity. Comput Educ. 2020;159:104024. doi:10.1016/j.compedu.2020.104024
- 4- Mirza, Noeman & Staples, Eric. (2010). Webcam as a New Invigilation Method: Students’ Comfort and Potential for Cheating. The Journal of nursing education. 49. 116-9. 10.3928/01484834-20090916-06.
- 5- The Guardian. Students alarmed at Australian universities’ plan to use exam-monitoring software. 20 April 2020. https://www.theguardian.com/australianews/2020/apr/20/concerns-raised-australian-universities-plan-use-proctorio-proctoruexam-monitoring-software
- 6- State Sponsors: Sudan. April 2008. https://www.cfr.org/backgrounder/state-sponsorssudan
- Membership of the Royal Colleges of Physicians of the United Kingdom. Examination centres https://www.mrcpuk.org/mrcpuk-examinations/specialty-certificate-examinations/examcentres
- Bureau of Counterterrorism. State Sponsors of Terrorism. https://www.state.gov/statesponsors-of-terrorism/
- Sarah Gillam. The Kitchener School of Medicine: 20th-century medical education in Sudan. 2017. https://history.rcplondon.ac.uk/blog/kitchener-school-medicine-20th-centurymedical-education-sudan
- 10- Hashim A, Abdelrahim E, Shaheen S. The point of departure: career goals of final year medical students in Sudan. AMEE conference 2018. Abstract: 9DD11 (1604). 11- BBC. Sudan’s listing as sponsor of terrorism ended by US. 14 December 2020. https://www.bbc.co.uk/news/world-africa-55300252
Dr Ahmed Hashim is a SpR in Gastroenterology and Hepatology at Royal Surrey County Hospital in Guildford. He is the media officer for the UK branch of the Sudan Doctors Union.