Abstract:

Introduction:
Specialist exit examinations for doctors are meant to ensure that a stringent level of quality assurance is met to keep patients and the community safe. Despite having to jump through the hurdles of multiple examinations during the undergraduate period, most clinicians find postgraduate examinations to be particularly difficult. The pass rate at first attempt for most postgraduate medical examinations are relatively low. These exit examinations are considered to be high stakes as they have a significant impact on career demand and are crucial towards progression. In the United Kingdom, the postgraduate specialist examinations are regulated by the Royal Colleges for each specific specialty. For example, The Royal College of Emergency Medicine regulates the Fellowship examinations. The curriculum and standard setting are regulated by the General Medical Council. Due to the stringent regulations and oversight, postgraduate medical exams in the UK are highly reliable and are recognised internationally. Lack of preparation is considered to be the main contributory reason towards failure, however at the postgraduate level it is not the easiest to juggle between career, family life and educational commitments. The monetary cost for attempting the exams are also high.

Methods:
A rapid, structured literature search was conducted on PubMed and Google Scholar to identify articles which explicitly identify reasons for poor performance in UK-based high stakes postgraduate medical examinations. Only articles written in English were included.

Results:
Possible reasons for poor performance in postgraduate medical examinations include a) poor organisational skills, b) lack of preparation, c) lack of support, d) language barriers and e) differential attainment due to gender/racial factors/examiner bias. Differential attainment is defined as the gap in achievement between different demographic groups attempting the same examination.

Discussion:
Failure in examinations can be devastating especially when significant amount of time and effort is invested towards preparation. Even though exams are important, it doesn’t define one’s clinical practice. However, failure should be seen as avenues for improvement and character building. Developing generic skills such as time management and self-leadership could reduce the burden of juggling between a stressful job, coping with family responsibilities and preparing for exams. It is suggested that differential attainment seen in high stakes postgraduate medical examination is due to language, educational background and cultural differences. Being aware of the main reasons for poor performance would provide an edge in planning out a preparation strategy. A pragmatic stance towards attempting postgraduate medical examinations would be to; employ a critical approach by identifying one’s gaps in performances and directing preparation towards improvement. Further research is needed to explore contributory factors in differential attainment, especially in high stakes postgraduate medical education.

Keywords:

High stakes examination, medical education, differential attainment.