Postgraduate medical examinations: should the number of resits be limited?

When medical students graduate in the UK, they must undergo further postgraduatetraining  and assessment before qualifying as specialist doctors. This involves a two-year foundation program, followed by core medical training and specialty training. Membership of the Royal Colleges of Physicians of the United Kingdom (MRCP(UK)) examinations are undertaken at various stages of training to be a specialist; graduates are first eligible to take the MRCP(UK) Part 1 examination after the first foundation year, and the full MRCP(UK) diploma is required before specialty training can commence.

In a study published in BMC Medicine,
McManus and Ludka examined candidates’ performance in the MRCP(UK)
examinations, and assessed whether results improve with multiple
attempts at the same examination. A number of graduates resit the
examinations because failure rates are often high; the pass rate for
MCRP(UK) Part 1 was 35.5% of all candidates in 2012, and 43.2% passed the clinical PACES examination in 2011.

There
is currently no limit on the number of attempts candidates can have at
each of the MRCP(UK) postgraduate examinations. The UK General Medical Council (GMC) raised the issue of whether there should be a maximum number of six attempts in April 2011,
but a consensus has not yet been reached. This is currently under
debate because a number of issues surround resit examinations that have
not yet been addressed; a key question is whether candidates get better
or luckier with multiple attempts.

McManus’
study addressed this question using multilevel mathematical modeling to
analyze more than 23,000 attempts at each MRCP(UK) examination. The
results indicate that candidates’ performance improves with multiple
attempts, and continues to improve up to the tenth attempt in MRCP(UK)
Part 1 examinations. Performance improves up to the fourth attempt in
MRCP(UK) Part 2 and up to the sixth attempt at PACES examinations.

Whilst
these results do not support the GMC’s suggestion that candidates
should only be allowed to sit an examination a maximum number of six
times, the authors also highlight that we cannot justify unlimited
attempts because luck plays a growing role in the likelihood of passing
with increasing numbers of resits. McManus suggests that as a possible
solution, the pass mark could increase with the number of attempts each
candidate has made, to ensure that those who pass after retaking the
examination have genuinely improved. This would ensure that patients are
protected, whilst allowing the candidates whose performance gets better
with multiple attempts to pass the examination.

The
results from McManus’ study should inform future decisions about
whether the number of attempts should be limited and if so how many
attempts should be allowed, in order to permit the improved candidates
to pass whilst maintaining a good
standard of patient care. As many countries model their medical training on the UK system, and a number of international doctors take the MRCP(UK) examinations, the findings from this study could also inform decisions on examination resits by overseas medical associations, and have important implications for international graduate medical training.

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