MRCPsych Clinical Exam should be restored to the old pattern.

In 2007, the Royal College of Psychiatrists suddenly announced that the part 2 would no longer consist of long case and patient management problems and would consist of OSCEs. In the first exam of the new pattern in June 2008, the college passed around 60% of the candidates. However in the subsequent exams the pass rate suddenly dropped to 30-37%. The number of stations required to pass also became high from 66% (8/12) to 75% (12/16) . In the previous exam pattern before 2008 the number of native and foreign psychiatric trainees were not very different. However in the new exam pattern more than 95% of the native English speaking people do pass meaning that only 5% of them do fail. That means that if 50 of them appear in the exam, 47 would pass. However among non-native candidates this ratio is only 30 -35 % means that only 200 would pass from 550 applicants and the rest of 250 people will fail no matter they have worked extremely hard for the exams, did loads of practice, attended loads of courses (even more than 19) and yet they fail. One of the big factors in failing is the lack of fluency which actually means that slow rate of speaking English. Due to their slow rate of speaking English, non-native candidates cannot complete the required checklist despite having excellent communication skills otherwise including reflecting back, empathy, rapport building and eliciting and exploration of symmptoms. Unfortunately the stations are never video filmed and therefore no one can challenge the exam results. Also when the native people speak English to the patients they sound very natural it is their first language and non-natives seem artificial no matter how much knowledge and skill of practicing psychiatry they have. The previous pattern of long case was changed to reduce the subjectivity of the exam and to make it more objective. But that is not the case now. The CASC is very much subjective. It depends on various factors including the speciality in which the examiner is working, the role player's temprament, the day of your exam 1st, 2nd, 3rd or 4th and the boredom of examiners and role players. Also there is no objective checklist and the result solely depends on examiner's feeling about you. In that way it is even more subjective than the long case & PMP pattern. To conclude there is a huge language and culture bias as well as subjectivity in the new CASC exam. Therefore, it is requested that the old style part 2 clinical exam should be restored and it should entail long case and patient management problems rather than OSCE style CASC. This would not make the exam objecive but at least it would be helpful in reducing the subjectivity.

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    Gihan Abeywardena, Sri Lanka

    5 years ago Comments: The long case and the PMP is a much more objective way of assessing the skiils of a psychiatric trainee than the CASC. It involves critical thinking, coming to a diagnosis and discussing treatment options, which is what you do with your patients in actual clinical day to day practice. CASC is a very artificial, crude way of assesing clinical skills and is very subjective.
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    Ankamma Rao Kandru, United States

    5 years ago Comments: -
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    salwan jajawi, United Kingdom

    5 years ago Comments: yes i agree
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