KFP and AKT: What is the RACGP doing?

Doug Hendrie

2/11/2020 3:53:26 PM

Pointed questions from candidates over the cancelled exams have been answered by key college figures in a wide-ranging Q&A session.

Q&A video online
RACGP leaders outlined what went wrong after the exam cancellation.

The Q&A session comes as the RACGP announced a new paper-based re-run of the postponed Key Feature Problem (KFP) exam and Applied Knowledge Test (AKT) will go ahead on Friday 4 and Saturday 5 December in COVID-safe settings. 
Chair of the National Faculty for GPs in Training Dr Krystyna de Lange expressed her regret and sorrow at the stories emerging from candidates.
‘It’s heart-wrenching. As someone who sat these exams recently, I too made a lot of these sacrifices and a lot of life decisions based on these exams, including my own decisions around pregnancies and having children,’ she said.
‘It’s been heartbreaking to read those stories and see those impacts and to put myself in the shoes of the trainees to think about what they are going through.’
Unreserved apologies for the exam failures were given by all four Q&A participants – Acting President Associate Professor Ayman Shenouda, CEO Dr Matthew Miles and Censor-in-Chief Dr Tess Van Duuren, as well as Dr de Lange.
‘We are acutely aware of the blood sweat and tears that goes into preparations. To say it was a disappointment would be a gross understatement,’ Dr Miles said.
‘We are deeply sorry about the failure of this exam.’
The Q&A covered the most common questions from more than 350 submissions.
What went wrong?
The most-asked question was a simple one: what, exactly, went wrong?
‘The best way to describe it is that the online platform failed to scale for [the] sheer number of candidates we had. That left that exam not being able to continue,’ Dr Miles said.
‘With that then came the necessary decision that we had to cancel the next day’s exam as well.’
Dr Miles said feedback from mock exams had flagged some issues around remote proctoring, but that was not the cause of the exam failure.
The external provider, Genix, had been used by the college for nearly a decade.
Dr de Lange said the RACGP has made a decision to ‘pivot’ away from this provider, which means trying to engage a new vendor for a high-quality remote exam in a short timeframe would not be possible.
In response to a question about compensation for emotional distress and lost income, Dr Miles said there were many reasons candidates would be out of pocket.
‘What I can say is we’ve put Genix on notice regarding potential claims. We’ve asked them to put their insurer on notice and that there are also relevant insurance arrangements in place,’ he said.
Dr Miles acknowledged there is ‘absolutely no doubt’ communication during the exam was slow.
‘There was certainly what I would call an information vacuum where the team at the RACGP was frantically trying to receive further information from our third-party provider, but that information was not forthcoming in a timely manner,’ he said.
‘Of course, that’s not an excuse. There need to be better ways of managing that.’
New exams
Dr de Lange said RACGP staff members have been working ‘quite literally around the clock’ to look at resit options.
‘The focus has been on reliable, safe and on time. We cannot at this point let candidates go through what happened a few weeks ago,’ she said.
‘The decision to go with the paper-based option has been made after careful consideration of all of the options.’

The 30-minute universal allowance in place for both exams will be retained, and an additional 30 minutes will be added to the KFP. This means the KFP and AKT will both be four-hour paper exams. The number and type of questions will remain the same. 
In response to concerns about COVID safety while sitting exams, Dr de Lange said the RACGP is not using its traditional large exam centres, and instead plans to use approximately 40 smaller centres around the country. Special arrangements will be possible for those who live more than 200 km from one of the venues, or those stuck overseas due to COVID. 
‘As much as possible we want to minimise the travel requirements for candidates so that they’re not further put out by this, but we also have to be mindful of reducing the numbers in any one centre so that you know the numbers of candidates that are gathering are manageable from a COVID-safe perspective,’ she said.
‘I want to stress that keeping candidates safe is our absolute priority.
‘I know that there will be many of our candidates that will worry about this. I want to reassure you that we are working with venues and governments to ensure that the execution of the exams is done in a COVID-safe way. Some of these precautions are going to vary across the country. What’s required in Victoria and New South Wales … might be very different to what’s needed in other regions.’
Free resits and exam caps
Dr de Lange said candidates can withdraw from the December exams and sit in the first exams next year as part of the RACGP’s offer to resit the exams free of charge.
‘We have announced that there will be an increase in the exam cap for all candidates affected by this cancellation, from six cycles up to seven cycles,’ she said.
It is likely many candidates would have already exhausted much of their workplace leave, Dr de Lange said, due not only to study but also the need to self-isolate if they have respiratory symptoms.
‘A lot of people have been impacted and had their leave impacted this year for a number of issues. Unfortunately, as the college we’re not in a position to compel practices or to force practices to grant extra paid leave above and beyond what would normally be allowed,’ she said.
Dr de Lange encouraged candidates to have an open and frank conversation with their practice and supervisor about the need for any extra leave now that the new dates have been released.
Exam costs
The cost of exams was another common question topic.
Dr Miles estimated around one third of all RACGP staff members are involved in the provision of the exams, which he described as a major component of the cost. 
‘It’s a very, very complex, time-consuming, resource-heavy process,’ he said.
Dr Miles said his ‘great hope’ for the future is that remote exams become a cost-saving measure.
Candidate support
RACGP staff members have been calling individual candidates, though given the number of people affected, not everyone had been personally contacted yet.
‘It’s a huge task and it is still ongoing, but we want to reach out to every candidate that was affected with a personal phone call,’ Dr de Lange said. ‘[I]t is taking time because we want to be able to give them the space and the time to be able to answer questions.’
Dr de Lange said international medical graduates may have ‘unique issues’ regarding visas and residency requirements, and the RACGP is supporting these candidates as much as possible through discussions with the Department of Health, the Department of Home Affairs and Services Australia, as well as the Medical Board of Australia.
‘We are trying to do as much as we can in that space,’ she said.
‘For many of our affected candidates, the best thing we can do to support them at this point is to just get on with our job of delivering these exams. Our trainees are well and truly over it, to be honest.
‘Most of them would have started studying or preparing for these exams at the end of last year. They’ve already had it delayed once from July to October and then they faced this disaster.
‘For many, they would probably describe it as some form of prolonged torture … and they just want this over with.
‘They want their training on track, they want to get on with their lives, they want to go back to some semblance of normality, they want to be able to tuck their kids into bed at night.
‘They don’t want their loved ones and children asking them when mummy or daddy can stop studying.’
Progression through training
Dr Van Duuren acknowledged it is a ‘tightened timeline’ for candidates who plan to resit the exams in December, as well as the Remote Clinical Exam (RCE), which has already been moved to March.
‘I would suggest to candidates that are contemplating that, or may be concerned about this, that focusing for the knowledge components and the clinical reason components and the way that they apply that knowledge for the written exam is excellent preparation for the RCE,’ she said.
‘Sitting and seeing patients in their practice, focusing on being patient-centric, polishing their communication skills, and polishing all their other components of clinical skills, will still sit them in good stead so once they’ve completed these written exams they could hopefully quickly then shift around and start practicing for the RCE format.’  
Special consideration
In response to questions over whether the exam requirement could be waived for this cohort, Dr Van Duuren said that although there is no doubt the ‘ball was dropped’ on delivery of the KFP and AKT, the RACGP would not drop its standards of Fellowship. 
‘I don’t know that any candidate would really want to know that the standard that they have or that the Fellowship certificate warrants is in any way compromised because of this,’ she said.
‘I think we all know the Fellowship warrants that someone is a specialist GP. That has to be earned and there are requirements that candidates have to demonstrate competence at a certain level to earn that.
‘While I understand that people would like to simply progress and not have to sit this exam, that’s not going to happen.’
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Dr Bahareh Shafaei   3/11/2020 6:56:49 AM

I am wondering how the paperbased exam would be able to provide the candidates with the fair presentation of questions since many questions include imaging for the correct diagnosis and management. How a small pneumothorax could be seen or different kind of rash identified?

Dr Elham Khalili   3/11/2020 7:32:48 AM

And no mention of the fact that IMGs who had only 3 attempts due to PEP starting in 2022 (already unfair) Now have only 2 attempts. STOP THIS DISCRIMINATION.

Dr Roshan Laknath Fernando   3/11/2020 8:14:10 AM

I believe like others, this should be assessed through the royal commission as there were a lot of unanswered questioned

Dr Daniela Elena Radulescu   3/11/2020 11:14:21 AM

It is amazing how much all these big organizations spent in terms of time and financial efforts for things like risk mitigation or liability prevention. To the point the work place is transformed by lawyers and management planers and employees forget the reasons why they work there in the first place. And when a major overhaul like COVID happens they are still in frozen mode. ..Hm...

Dr Parinaz Alirezaei   11/11/2020 5:38:36 PM

IMG drs should have their 6times attempt before entering PEP programme,its not fair to be stopped in the middle of the exams for the drs who already started the exams,i am working in monash 1 and it was even before the news release about this PEP programme,we are so distressed by this,i hope racgp give us the chance to pass the exams (6attempts)as most of us dont have the option of entering the PEP due to wotking in monash 1.I hope RACGP thinks about issues of IMG drs:(