Raising the quality of international general practice

The final exam on the pathway to Fellowship of the RACGP (FRACGP) – the Clinical Competency Exam (CCE) – was introduced in 2021 to replace the college’s Remote Clinical Exam and the Objective Structured Clinical Examination.
 
Held twice a year, the CCE is delivered online.
 
Across international waters, the CCE is also delivered in a hybrid format across two weekends to Fellowship candidates in Malaysia.
 
The Academy of Family Physicians of Malaysia’s (AFPM) is accredited by the RACGP and delivers conjoint exams through a Memorandum of Understanding. Successful candidates are awarded the International Conjoint Fellowship of the RACGP (ICFRACGP) and are members of the college. 
 
The online component of the 2022 AFPM CCE took place 3–4 September, with the face-to-face held on 17–18 September – the first in-person clinical exam the AFPM undertook post-COVID. The plan is to move to face-to-face only from next year. 
 
RACGP representatives, Censor-in-Chief Dr Tess van Duuren and CCE National Assessment Advisor Dr Rebecca Lock flew to Malaysia as quality assurance examiners for the AFPM exams.
 
Both were pleased to have the opportunity to support the AFPM exams in person.
 
‘The college has a longstanding relationship with the AFPM,’ Dr van Duuren told newsGP.
 
‘We have developed good working relationships with our AFPM colleagues, but it’s not the same meeting them in a Zoom room as actually being in the exam venue with them. 
 
‘Since I have been Censor-in-Chief it has has not been possible [to attend in person], so this was the first time we could visit.’
 
The latest AFPM exams were an example of the huge effort involved in successfully running clinical exams.
 
While Dr van Duuren and Ms Lock quality assured the examiners and provided feedback to the assessment team at AFPM, the RACGP also provided question development support through its National Clinical Lead – Assessment, Dr Gary Butler. 
 
The AFPM clinical exam had 45 examiners and four trainee examiners, supporting 81 candidates – of whom 84% passed the exam. In addition, 20 coordinators assisted with running the online exam and 18 with the face-to-face version.
 
‘The coordinators are all recent graduates who have been invited to be involved in the exams,’ Dr van Duuren explained.
 
‘Their involvement means that they are engaged in the exam process soon after graduation and many will progress to become examiners.
 
‘We were impressed with their cheerful professionalism and willingness to be involved in activities that support the smooth running of the exam.’ 
 
Fifteen AFPM staff were also involved in the running of the exam, for which Dr van Duuren is grateful.
 
‘It’s not often that we have [for example] the President doubling up as chauffer for the RACGP delegates, then spending the day role playing for the exam,’ she said.
 
‘It seems that everyone at the AFPM was happy to be involved and give up their precious time to do so.’ 
 
Dr Lock agrees it was a valuable international partnership opportunity to support exam candidates.
 
‘It was such a pleasure and privilege to travel and take part in the AFPM exams,’ she told newsGP.
 
‘It was wonderful to meet the team of examiners who are so enthusiastic. They are a very dedicated group of examiners who hold the responsibility for setting the standard of care delivered in general practice.
 
‘They take this responsibility very seriously and work with the academy to mentor candidates across Malaysia as they prepare and also engage in significant advocacy for the standard and recognition of the speciality of family medicine/general practice.’  
 
In Malaysia, primary healthcare ‘looks different’, according to Dr van Duuren, with many family physicians employed to work in university clinics or hospital settings.
 
The ICFRACGP is recognised in Malaysia as a specialist qualification, and by gaining it, Malaysian GPs gain specialist status.
 
‘This translates into a higher salary for them, but the real benefit is in the quality of healthcare for their patients,’ Dr van Duuren said.
 
‘By supporting the AFPM we are contributing to raising the profile and quality of general practice in Malaysia. Our AFPM colleagues value our support and the guidance that we have provided to them over the years.’
 
While the RACGP’s National Assessment Advisor team provides quality assurance for each AFPM CCE as part of its ongoing support in the partnership, the college also reviews and suggests ways to improve the CCE at the post-exam meetings – all of which are based on quality improvements that the RACGP has put in place over time.
 
At the most recent meeting, Dr van Duuren said the team was ‘impressed to hear’ that some of the college’s suggestions had already been implemented. 
 
‘At the RACGP we are privileged to have excellent resources at our disposal, which the AFPM does not,’ she said.
 
‘By offering this support we have “bootstrapped” them to a high standard and they will be able to stand on their own feet in the not-too-distant future.’ 
 
The AFPM is seeing a growth in demand for their training and qualification and are now preparing for 2023, when around 200 candidates are expected.
 
‘It’s great to see the increased interest in gaining general practice qualifications,’ Dr van Duuren said.
 
‘Four delegates from AFPM will also be joining us for GP22, and we look forward to welcoming them soon.’ 
 
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Academy of Family Physicians of Malaysia CCE clinical exams Fellowship of the RACGP international partnerships quality assurance