Specialist exams - time for change?

This week, a thousand-odd medical and paediatric registrars sat the “exam of their lives.” Lives which were put on hold for over a year, with patient families waiting in the wings, hospitals on skeleton staff, thousands of dollars spent, all culminating in what will invariably go down as one of Australia and New Zealand’s worst vocational educational debacles.

As someone on the other side of the FRACP nightmare, I watched with sympathy and horror as two separate events unfolded: the absolute outpouring of grief and dismay from my BPT colleagues on social media, and the emotionless initial response from their respective college. The disconnect between those who set the exam and those who sat it was clear. On one side, tales of candidates crying on kerbsides (1), going home to children only to tell them that unfortunately study wasn’t finished yet, local directors of physician training and other senior clinicians and trainees fielding phone call after phone call from inconsolable registrars, and on the other, a haphazard and badly co-ordinated series of missteps, with no reference to the mental health impact, and concerningly, no reference to local and national support centres. Let’s not forget that this time last year, Chloe Abbott committed suicide prior to sitting this very exam.

The true impact and fallout of this event will surely come to light in the coming months, but in the meantime, my thoughts have been continually wandering over to the question that, 2 fellowship exams later (one which is still not over yet) I cannot help but keep asking– is this really the best way to train our specialists? Is it time to question the status quo?

Let’s look at the current format of how most of our specialists are trained. We have a two to six plus year training program, in which time we are supervised and immersed in our speciality of choice. There are often two major hurdles in the format of examinations – one at the start and one at the end of our training. The examinations cost tens of thousands of dollars, by the time you add course fees, examination and travel costs. A year or more of (often) full time work and intense study culminates into a five hour test that does not respect whether you have not slept, are tired, are pregnant, coming off night shift or have spent all night consoling an upset child. I am particularly distressed to learn that a breastfeeding woman was not allowed to express during her examination (1). It’s no wonder then, that in this high-stakes, high-stress situation, one life event, one work or personal crisis, one bad day may derail the entire effort. It is literally a “sudden-death” exam.

The impact on women and primary carers of children and elders cannot be discounted. I have lost count of the (predominantly) women I have encountered who have not been able to set aside the massive amount of time require