Dyslexia Could Affect Pass Rates in UK GP Clinical Skills Exam

Trainee doctors who have dyslexia, and who declare this prior to taking the clinical skills component of the licensing exam for general practice, are less likely to pass than their counterparts, new research has shown.

The Clinical Skills Assessment (CSA) is a scenario based clinical exam designed to test a doctor’s ability to gather information, make evidence-based decisions, and communicate effectively with patients and colleagues. The test is part of the three component qualification to become a Member of the Royal College of General Practitioners (MRCGP) which licenses doctors to practice independently as GPs.

The study led by researchers from the Community and Health Research Unit (CaHRU) at the University of Lincoln, UK in collaboration with the MRCGP, examined pass rates of 20,879 candidates who had taken the exam from 2010 to 2017 of whom 598 declared dyslexia. Findings showed that once other factors linked to exam success such as number of exams sat, initial pass mark, dyslexia, sex, ethnicity and country of primary medical qualification were taken into account, those who declared dyslexia were less likely to pass, and fared even worse if their declaration of dyslexia was delayed after failing at least once.

Interestingly, the findings of the study, which is the first to examine pass rates in the CSA, differ from a previous study into the Applied Knowledge Test (AKT) – a multiple choice written component of the MRCGP. The previous study found that dyslexia did not reduce pass rates for those declaring their learning difficulty prior to taking their exams, suggesting that the CSA may not be less problematic than written components for candidates with dyslexia as previously thought.

The study also found that candidates who declared dyslexia were more likely to be male (47.3 per cent compared with 37.8 per cent of females) and more likely to have gained their primary medical qualification outside the UK. Once other factors were taken into account, sex was not shown to have an effect on pass rates and trainee doctors from minority ethnic backgrounds were slightly more likely to pass than white British or Irish candidates.

The research has highlighted the need for further research into the aspects of the CSA exam that candidates with dyslexia find more difficult and how these challenges could be addressed to better support candidates.

Lead author Dr Zahid Asghar, from the University of Lincoln’s Community and Health Research Unit said: “Doctors with dyslexia, particularly those who declare the condition after failing at least once, possibly because they are unaware of the condition or worried about declaring it, have a higher chance of failing. This suggests we need to understand more about what trainees with dyslexia find difficult about the clinical exam and what can be done to help”.

Corresponding author Niroshan Siriwardena, Professor of Primary and Pre-Hospital Care at the University of Lincoln and Research Lead for Assessment at the RCGP added: “Researchers from CaHRU together with colleagues from the MRCGP exam have been investigating differential attainment in the exam and its causes for some time, and our research is beginning to reveal important clues about why certain groups of doctors do less well at certain parts of the exam and what might be done to alleviate this.”

The paper was published online in Medical Education. The full paper can be accessed here: https://onlinelibrary.wiley.com/doi/full/10.1111/medu.13953