Membership Examination Research Articles

Obstetric medical care and training in the United Kingdom.

The UK confidential enquiry into maternal deaths identified poor management of medical problems in pregnancy to be a contributory factor to a large proportion of indirect maternal deaths. Maternal (obstetric) medicine is an exciting subspecialty that encompasses caring for both women with pre-existing medical conditions who become pregnant, as well as those who develop medical conditions in pregnancy. Obstetrics and gynaecology trainees have some exposure to maternal medicine through their core curriculum and can then complete an advanced training skills module, subspecialise in maternal-fetal medicine or take time out to complete the Royal College of Physicians membership examination. Physician training has limited exposure to medical problems in pregnancy and has therefore prompted expansion of the obstetric physician role to ensure physicians with adequate expertise attend joint physician-obstetrician clinics. This article describes the role of an obstetric physician in the UK and the different career pathways available to physicians and obstetricians interested in maternal medicine.

Editor’s ChoicePaving the way to general practice

Currently, there is only one way into a career as a doctor in general practice. This is to pass the membership examination of the Royal College of General Practitioners (the MRCGP exam). Kamal Sidhu believes that it is time not only to update the exam but also to think about whether we should …

Noshir Hormusjee Wadia

Pioneer in Indian neurology Noshir Hormusjee Wadia, one of the founding fathers of neurology in India, was at the vanguard of the development of neurological sciences in the country. Born...

The Part 1 MFSRH Examination: the new Single Best Answer paper

In accordance with best practice in medical assessment, the examination for Membership of the UK Faculty of Sexual & Reproductive Healthcare (MFSRH) has evolved over recent years, refining the test...

“‘Need a Minister? How About Your Brother?’: The Universal Life Church between Religion and Non-Religion”

National media outlets have observed that weddings in the United States, especially for young educated people, are increasingly performed by ministers who are friends or relatives of the couple and who become ordained online just for that purpose. The primary organization licensing these ministers, and thus authorizing these weddings as legally valid, is the Universal Life Church (ULC), which has ordained over 20 million people since 1962. To date, there has been no focused study of the ULC or lifecycle rituals conducted under its auspices. According to my original survey, interview, and participant observation data, both ULC ministers and the couples who engage them typically self-describe as non-religious, usually as spiritual, seekers, humanist, or generically “not religious.” Similarly, they describe their weddings in “non-religious” terms, emphasizing the personalization of the ceremony to match their particular beliefs and tastes as well as the conscious exclusion of most “religious” language. These “secular” or “spiritual” wedding ceremonies reveal non-religious couples’ desires for an alternative apart from bureaucratic civil ceremonies or traditional religious rites. This article explains why “secular” people select ULC ministers for their weddings, how ULC ministers see themselves as “non-religious” while being members of a legally-recognized religion, and how ULC ministers and couples married by them label and valuate their “non-religious,” personalized wedding ceremonies. My examination of ULC membership and weddings reveals not only the diversity of non-theistic self-identification and lifecycle ritualization, but also how constructs such as “religious” and “secular” can be co-constitutive rather than purely oppositional.

Raising the standard: it's time to review the MRCPsych examinations.

The MRCPsych examinations are the qualifying examinations for membership with the Royal College of Psychiatrists and are generally undertaken in the second and third year of core training. In combination with workplace-based assessments and the Annual Review of Competence Progression (ARCP) the exams are essential to progressing to advanced training and eventually a Certificate of Completion of Training (CCT). The exams currently involve three multiple choice (MCQ) format papers and a single clinical skills examination consisting of 16 varied stations (Clinical Assessment of Skills and Competencies, CASC). No one doubts that to pass the exams necessitates a significant investment of time and energy, which detracts from trainees' experience on clinical placements, other educational opportunities, and their personal lives. Trainees' efforts should be rewarded with a process of learning and enrichment that develops their skills and knowledge, not simply another ‘hoop to jump through’ on their way through training. The MRCPsych courses offered by training hospitals go some way towards providing additional education, however, it is significant that trainees universally rely on practice questions rather than course attendance to pass exams. Some trainees will even pay for additional, privately run courses that focus solely on preparation for the exams. This suggests a fundamental disconnection between the exams and the learning objectives of training programmes that needs to be bridged. The curriculum available to trainees is vague and fails to provide any real guidance towards training in the first 3 years. Content is frequently outdated and does not reflect the realities of clinical practice. The MCQ format is overly reliant on rote memorisation of lists of facts without regard to the context and complexities of clinical decision-making. The exam process neither encourages nor rewards trainees who take time to read broadly around the curriculum themes, instead relying on a narrow set of questions that are recycled year after year. There is a lack of depth in the content tested, exemplified by the ‘history’ component which requires trainees simply to associate a list of important figures with a one-line description of their contribution. No attention is paid to the complex history of Western psychiatry or to important issues that are ongoing. Psychiatry more than any other field of medicine suffers from controversy regarding its role and relevance, and questions about aetiology, nosology, treatment and ethics. It is crucial for trainees to progress with an appreciation of these topics, yet the MRCPsych exams completely fail in this regard. I suggest that a complete review of the MRCPsych curriculum and examination is overdue. The MCQ component should be reduced in favour of short-answer and/or clinical scenario formats. The curriculum should be updated to include more current research in basic sciences, as well as milestone papers in the history of psychiatric research. Historical, cultural and philosophical themes should be included in the curriculum and represented in assessments. Learning objectives for each theme should be specific, and accompanied by essential reading lists to guide trainees and exam questions. In summary, if the goal of training is to produce highly skilled, well-rounded trainees, then the curriculum and examinations should reflect this. Instead, they assess a bare minimum level of competency, neglecting important developments and issues that are highly relevant to our daily practice. I believe that new psychiatrists deserve more than ‘minimal’ competence in return for their efforts, as does the profession, and most importantly, our patients.

Abstract B73: Do generational cohort differences in social networks influence persistent and sporadic screeners' perceptions of breast cancer screening?

Abstract Purpose: Low breast cancer screening participation and adherence to guidelines is problematic. Our prior work found that on average 18% of women from four tribes adhered to Indian Health Service (IHS) mammographic screening guidelines over five years (study funded by Native American Research Centers for Health (NARCH IV). We sought to identify how adherent (persistent) and non-adherent (sporadic) screeners may differ by demographic and theoretical mediators that have successfully guided interventions in other health disparities populations. As part of planning interventions to increase AI/AN women's persistent screening, we characterized differences in persistent and sporadic screeners' responses to Social Norms and Health Beliefs in the context of social networks. Methods: From 2013-2014, we interviewed 55 recruited women (41 sporadic screeners and 14 persistent screeners) who had been randomly assigned unique identifiers. Data from interviews included demographic characteristics, assessments of health literacy, and social relationships from theoretical perspectives of: Theory of Planned Behavior, Social Support, Social Norms, Health Beliefs, and Social Networks. In this study, we examined areas that distinguished persistent from sporadic screeners—social norms and health beliefs--and we conceptualized the make-up of screeners' social networks to consider members by their generational status relative to the screener. We coded and categorized data; Fisher's Exact Test and Kruskal-Wallis Test were applied as appropriate. Results: We identified three mediators with four significant differences. 1. Social Norms: (A) Persistent screeners were significantly more likely to believe reservation women favored getting an annual mammogram while sporadic screeners were more likely to believe women were against getting annual mammograms (P = 0.03). Responses are consistent with Social Norms theory, but screeners' beliefs about friends' screening participation appear less consistent with the theory. (B) Persistent screeners by a large proportion believed friends obtained fewer mammograms than themselves while sporadic screeners had no prevailing view (P = 0.02). 2. Health Beliefs (susceptibility to breast cancer): (C) While sporadic screeners expressed considerable uncertainty about their susceptibility, persistent screeners expressed no uncertainty (P = 0.02). 3. Social Networks: (D) Examination of the generational membership of screeners' Social Networks showed that sporadic screeners' networks had significantly more members from generations younger than themselves compared to persistent screeners' networks ( P = 0.01). Conclusions: Screeners with younger social networks may in part be influenced to be sporadic screeners because they do not benefit from exposure to more mature and experienced individuals in their social networks. The excess of younger generation members in sporadic screeners' networks may expose them generally to people who do not screen (or have limited screening experience) due to age. This exposure would confirm for them that reservation women generally do not favor screening and would explain their mixed view of friends' screening behavior. The younger membership of sporadic screeners' networks also may explain why this group would express substantial uncertainty about their own susceptibility to breast cancer relative to other women. If the network is not of an age where breast cancer and screening are pertinent topics, screeners may not have a knowledgebase (accurate or not) from which to build their views. We anticipate further testing to ascertain the role of social networks in the views and behaviors of sporadic and persistent screeners before considering any interventions. Citation Format: Corinna Sabaque, Ann M. Nicometo, Robert Vierkant, Wesley O. Petersen. Do generational cohort differences in social networks influence persistent and sporadic screeners' perceptions of breast cancer screening? [abstract]. In: Proceedings of the Seventh AACR Conference on The Science of Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; Nov 9-12, 2014; San Antonio, TX. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2015;24(10 Suppl):Abstract nr B73.

RCGP announces rise in trainees’ membership fees and cuts to entrance exam costs

The Royal College of General Practitioners has increased the amount that trainees pay for membership but has cut the costs of its membership examination. The changes will mean that trainees starting in August 2015 will pay £595.43 more for associates in training (AiT) membership. The college said this increase in cost would be “largely offset” by a reduction of £409 in the combined fees for the clinical skills assessment and the applied knowledge test. It currently costs trainees £1780 …

Making it in British Medicine: Essential Guide for International Doctors.

The opening chapter, ‘Before leaving home’, concisely covers what the overseas doctor should expect and lists the essentials for training/working in the UK. The information on The Royal College of Surgeons of England and its rules are not fully detailed here but are dealt with in a later. The second chapter, ‘Medicine in Britain’, presents an introduction to the NHS and the different types of hospital in the UK. It encourages the overseas doctor to practise a multidisciplinary team approach, explains what constitutes a good team and the consequences of poor teamwork. However, the topic suddenly changes into talking about the British Medical Association, The Royal College of Surgeons of England and the pay banding for doctors. It is difficult to explain about medicine in Britain in 12 pages but we found this chapter informative despite being a little disorganised. ‘Career planning’ is the best chapter in the book. It describes all the essentials for career planning and choosing a specialty. It also explains the difference between training and non-training posts as well as the different grades in each, information that the overseas doctor will need to understand before coming to the UK. The section about ‘General practice in the UK’ stresses the importance of this part of the healthcare system to the NHS and also the career opportunities for overseas doctors wishing to work in the UK as a GP. The pathways into UK general practice are well described, as are the different types of practices. However, the rest of the information is not detailed enough and the overseas doctor would be best advised to research other sources to gain a full understanding of general practice in the UK. In the chapter entitled ‘Essential paperwork’, the authors cover what the overseas doctor should practise while in a hospital post. It is written in a clear and simple way in order to guide them into what the British hospital system expects of them in contrast to what they may be more used to. Topics covered include the doctor–patient relationship, making and taking decisions, clinical record guidelines, referral letters, etc. ‘Examinations’ is another good chapter and includes many hints on how to prepare for an examination (especially the IELTS, PLAB and MRCS) with sound advice on ‘strategies before talent and luck’. It also gives the reader information on each membership examination, including cost, courses, what textbooks to read, pass rate and many other useful tips. ‘Hard times’ gives the reader an introduction to real life away from home, what to expect and how to face failing exams. It also tackles the very sensitive issue of racism and guides the overseas doctor on how to cope and deal with stress in many ways. The final chapter, ‘Living in Britain’, gives broad, general information on living in the UK. It explains about banking, tax, health and money issues, accommodation, transport and entertainment. However, it also contains some unnecessary and not very useful information. In summary, we thoroughly enjoyed reading this book and were impressed with its content. This book will be invaluable reading for overseas doctors who already work or are considering working in Britain.

Investment-Based Citizenship and Residence Programmes in the EU

This paper has two objectives. First, by mapping investment-based the legal provisions that may result in the direct acquisition of citizenship or residence rights through a pecuniary contribution in all the 28 European Union (EU) Member States, it clears the grounds for further normative inquiries in this issue. Second, it discusses the iterative relationship between European Union (EU) citizenship and investment-based citizenship programmes, taking into account the intuitive conflict between the values inherent in EU citizenship and the opportunity structures that it creates for countries to commodify their membership by exchanging it for investment. The paper starts by a theoretical examination of membership in national and supranational polities in order to discern the links between national and EU citizenship. This is followed by an empirical classification of the different investor and residence programmes in the 28 Member States of the EU, aimed at comparing how different countries regulate access to membership on grounds of wealth. The conclusion to the paper discusses of the effects of investor citizenship and golden residence programmes in the broader EU context, taking into account the unique characteristics of European citizenship.

How to do well in the OSPHE: examiner comments about candidate performances in the Faculty membership examination Part B (OSPHE).

During Part B examinations, a number of observations and learning points are made by the examiners, who, after many years in that role, are in a position as highly experienced public health specialists to observe trends both in competencies and in examination preparation. We have prepared a briefing, based on these observations which we hope is valuable for exam candidates, for informing the examination committee about refinements, improvements and quality control of the exam, and to assist the Education Committee and Training Programme Directors in their ongoing monitoring of educational standards. We encourage all examination candidates and their trainers to look at the ‘top tips’ below which are all issues that we continue to see running through each examination, year on year.

GP trainers are invited to observe college exam, RCGP says

GP trainers are being invited to observe groups of candidates taking the membership examination for the Royal College of General Practitioners (MRCGP), the college’s chief examiner has said. Speaking at the conference of the British Association of Doctors of Indian Origin (BAPIO) in Manchester on Sunday 30 November, Pauline Foreman, the royal college’s chief examiner, said that she hoped to rebuild confidence in the exam. The rate of failure in the exam was found to be much higher among ethnic minority candidates …

Communication problems contribute to overseas doctors’ lower pass rate in MRCGP exam

Overseas doctors’ difficulties in communicating contribute to their lower pass rates in the membership examination for the Royal College of General Practitioners (MRCGP), researchers have found. A team from King’s College London looked at why medical graduates from overseas and UK candidates from ethnic minority backgrounds had a disproportionately high chance of failing the clinical skills assessment (CSA) part of the exam, in which examiners assess candidates’ clinical, professional, and communication skills during interactions with actors playing patients.12 They analysed 40 video recordings of candidates sitting the CSA test and reviewed examiners’ feedback and paperwork, excluding cases where there were clear and important clinical errors or mismanagement. The researchers found that poorly performing candidates were more likely to have difficulties explaining matters to patients. …

The evolving mental health landscape in Singapore

SummarySingapore is a multi-ethnic Asian society with a unique sociocultural and economic background. This is an overview of the characteristics of psychiatry in this nation in terms of service provision, mental health funding, education and training, and the challenges it faces in the midst of an evolving mental health landscape. Over the past 5 years, Singapore has maintained a closer tie with the Royal College of Psychiatrists through the the College's Membership examination.

RCGP will work with international doctors on membership exam issues

The Royal College of General Practitioners (RCGP) will work with international doctors’ organisations to address issues relating to its entrance exam. The college said that it would work with the British Association of Physicians of Indian Origin (BAPIO) and the British International Doctors Association (BIDA) to support candidates. BAPIO had previously brought a legal challenge against the RCGP and the General Medical Council over the examination for membership of the RCGP (MRCGP). In April a High Court judge ruled that the …

Ironing out difficulties

The plight of medical graduates from other countries wanting to work in the NHS has been brought into sharp focus in recent weeks. Last month’s judicial review into the membership examination of the Royal College of General Practitioners highlighted the importance of acting on information about disparities in pass rates across ethnic groups. Shortly after the judicial review, research …

Competency 1. Communicate effectively with patients, families, and the public, as appropriate, across a broad range of socioeconomic and cultural backgrounds

The ability to communicate effectively with patients, families, and the public is a critical skill for the medical professional and has been directly related to the outcomes of clinical care. 1 Stewart M. Effective physician–patient communication and health outcomes: a review. Can Med Assoc J. 1995; : 152-159 Google Scholar The importance of this is reflected in the medical education literature in consensus statements on essential elements of communication, 2 Simpson M. Buckman R. Stewart M. et al. Doctor–patient communication: the Toronto consensus statement. BMJ. 1991; 303: 1385-1387 Crossref PubMed Scopus (599) Google Scholar , 3 Participants in the Bayer-Fetzer Conference on Physician–Patient Communication in Med Educ Essential elements of communication in medical encounters: the Kalamazoo consensus statement. Acad Med. 2001; 76: 390-393 Crossref PubMed Scopus (584) Google Scholar in guidelines for medical school curriculum development, 4 Association of American Medical Colleges Medical School Objectives Project, Report III. Contemporary Issues in Medicine: Communication in Medicine. Association of American Medical Colleges, Washington, DC1999 Google Scholar , 5 General Medical Council Tomorrow's Doctors: Recommendations on Undergraduate Med Educ. General Medical Council, London, UK1993 Google Scholar and through increased emphasis placed on communication skills by professional practice organizations and accrediting bodies. 6 Communications Self-Evaluation Process (COM-SEP) Committee Minutes. American Board of Internal Medicine, Philadelphia, Pa1999 Google Scholar , 7 Tate P. Foulkes J. Neighbour R. et al. Assessing physicians' interpersonal skills via videotaped encounters: a new approach for the Royal College of General Practitioners membership examination. J Health Commun. 1999; 4: 143-152 Crossref PubMed Scopus (43) Google Scholar

BMA asks for GPs’ experiences of MRCGP exam

The BMA is calling on GPs to share their experiences of the Royal College of General Practitioners membership (MRCGP) examination.1 The association is asking GPs for their experiences of taking the clinical skills assessment component of the exam, which has come under scrutiny because of differences between UK and …

Distance Learning Improves Attainment of Professional Milestones in the Early Years of Surgical Training

To assess the impact of a surgical sciences e-learning programme in supporting the academic development of surgical trainees during their preparation for professional examination. In 2007, a 3-year online part-time Master of Surgical Sciences (MSc) degree programme was launched, utilizing an innovative platform with virtual case scenarios based on common surgical conditions addressed by the curriculum relating to the Membership Examination of the Royal Colleges of Surgeons (MRCS). Multiple-choice questions with feedback and discussion boards facilitated by expert clinical tutors provided formative assessment. Summative assessment comprised written examination at the end of each of the first 2 years (equivalent to MRCS level), culminating in submission of a research dissertation in year 3 toward an MSc. Students' age, gender, and level at entry to the programme were documented. Anonymized student feedback from 2008 to 2012 was examined using online questionnaires, and performance in the MSc programme was compared to MRCS examination outcomes for students who had consented to release of their results. A total of 517 surgical trainees from 40 countries were recruited over the 6-year period, and 116 MSc students have graduated to date. Of 368 students, 279 (76%) were foundation doctors (interns) and had not commenced formal surgical training on enrolling in the MSc programme. However, level at entry did not influence performance (P > 0.05 across all 3 years). Average pass rates since the programme launched, for those students completing all of the required assessments, were 84% ± 11% in year 1, 85% ± 10% in year 2, and 88% ± 7% in year 3 of the MSc programme. MSc students had significantly higher MRCS pass rates than nonenrolled trainees (67% vs 51%, P < 0.01, n = 352). There was a significant correlation between MRCS examination performance and overall performance in the MSc (R = 58%; P < 0.01, n = 37). Of 248 respondents, 202 (81%) considered that the MSc would improve their chances of gaining a surgical training post, and 224 (90%) would recommend the programme to their peers. The online MSc programme supports academic development of trainees in the early years of surgical training, is well received by students, and is associated with improved success in their professional examination.

Membership exam fees frozen for physicians but set to rise in other specialties

The fees for the examinations for membership of the Royal College of Physicians have been frozen for 2014, whereas fees for other royal college membership exams are set to creep up next year. The Federation of Royal Colleges of Physicians of the UK has announced that fees for the part 1, part 2, and part 2 clinical examination (PACES) of its membership exam will not increase between 2013 and 2014. The management board for the exams has said that it chose to freeze fees to recognise the difficult financial situation currently faced by junior doctors, such …