Are the RACP’s exams too tough?

medical education

By Geir O'Rourke

6 Nov 2023

The RACP says it is looking to review its notoriously challenging divisional examinations, amid concerns the pressure involved may be impacting trainees’ mental health.

It follows the release of results showing just 577 of the 825 candidates passed the adult medicine written divisional exam held in February and March this year, a pass rate below 70%.

Results were even worse in the previous edition of the exam held in October 2022, with only 46% of 100 candidates gaining the required marks.

RACP president Dr Jacqueline Small says the issues go beyond failure rates to the nature of the clinical and written exams themselves, which can make or break careers on a single day.

“I want to personally emphasise to you that our college is aware of the impacts to health and wellbeing of these enormously high stakes, summative examinations,” she said in an address to members last month (link here).

“Yes, being a physician is a challenging, at times confronting and ultimately rewarding occupation.”

“But training to be a physician should not be a trial by ordeal. Times have changed – and that thinking should change too.”

She referenced a “harrowing” account published in MJA’s Insight+ earlier this year (link here), detailing an anonymous trainee’s story of failing the clinical exam and how it had affected their life.

The trainee described juggling 13-hour shifts, study, sleep, relationships and relentless practicing of multi-choice questions, and, in their own words, `somehow’ managing to pass the Divisional Written Exam. Then they listed what they described as months of dedicated case presentations in preparation for the Clinical Exam, only to fail it.

Dr Small said she had been deeply moved by the story, adding she was pleased it had been shared as a powerful motivator for change.

To that end, the college’s recently appointed executive general manager of education, learning and assessment, Professor Inam Haq, was looking to undertake a holistic review of the role and structure of examinations in future, she said.

The scope of this review was still being decided, but the goal was to ensure exams were aligned with the new curricula for basic and advanced training, Dr Small added.

“Trainee health and wellbeing is a matter of ongoing concern for us, and we understand that there are issues with the current adult and paediatric divisional examination structures,” she said.

“We can and will maintain our high standards, but we also recognise that wellbeing is important. It’s important for quality health care and important for us as a community of physicians and paediatricians.”

“Many of the stressors for trainees during the examination cycle are workplace issues, and outside the college’s direct control. But we do have the ability to influence health and wellbeing, and culture in training settings through accreditation. We’re going to be reviewing our accreditation settings next year.”

“We’re also regularly working with other colleges and health jurisdictions to ensure health and wellbeing is a shared responsibility, and that issues can be raised quickly. Sometimes our professional journey can be very challenging and at times daunting. Mine certainly has been at times.”

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