The Royal Australasian College of Physicians (RACP), comprising more than 16,000 medical specialists, advises governments on matters of health and medical care, and has a respected voice in the community. However, its raison d’être is to train specialist physicians. 8,000 aspiring physicians are now in training. Assessing their road-worthiness includes a high-stakes, high-stress, ‘barrier’ examination.
This year’s exam, offered at 20 centres in Australia and New Zealand, was computer-based.It was a debacle.
Held on February 19th, it was a disaster for the 1,200 candidates. The software crashed repeatedly. Supervision procedures were erratic and unreliable. At some centres, candidates were locked in examination rooms for five hours, denied the use of toilets or attending to breastfeeding. In others, candidates were allowed to come and go, use their mobile phones and edit completed answers. After hours of confusion and uncertainty, the exam was cancelled. A new exam—in the traditional, paper-based format—was subsequently arranged for the 900 able to re-sit on 2nd March. As an emollient, all were refunded their $1,200 examination fee. (College’s loss, $1.4m!)
Trainees had sent a warning
Naturally enough, the trainees were upset and angry. They felt let down: training is already stressful enough; this débacle added to that stress. Worse, back in October 18tth 2017, a group of trainees had sent the College a detailed analysis of problems they had identified in the proposed computer-based testing. They waited six weeks for a cursory reply reassuring them that all was well and offering counselling if they couldn’t handle the stress! But underpinning their concern, was the unenviable record of failures, complaints, allegations and court actions involving Pearson Vue, the company contracted to conduct the examination.
This débacle leaves serious questions unanswered: Why was a company with this record chosen to supervise this important exam? Was due diligence undertaken before their appointment? Why wasn’t the system tested to make sure that it wouldn’t fail as forewarned? Does the contract allow for negligence claims against Pearson Vue or will the cost of litigation fall on College members? Is the College locked into a contract with Pearson Vue?
An independent inquiry – maybe?
The College plans an “independent” inquiry. Unfortunately, it seems that it will not be truly independent and its terms of reference might preclude a full investigation.
The terms of reference focus on the processes by which the decision to employ Pearson Vue was made, as well as the failure to respond appropriately to the trainees’ concerns. But the College is not conducting a full, forensic investigation. Indeed, the terms of reference avoid any investigation into accountability, potential major deficiencies in the contract, and risk to the College.
What would a genuine independent inquiry look like? It would be chaired by a former judge or SC, be able to assess whether improper or negligent conduct was involved and if so, to make appropriate recommendations. This inquiry should not be constrained by the interests of the Board nor the Executive and would consider not only the exam, in itself, but also the cultural and organisational structures within the RACP which enabled this chaos, despite the young doctors’ warning, to occur.
Instead, a commercial company specialising in insolvency investigations was engaged, and instructed to focus only on whether proper procedures had been followed. This leaves major questions unanswered. The inquiry also prevents directors, who are not on the Executive, from gaining access to relevant documents.
Beyond the recent crisis, other behaviours within the College cause concern. Allegations of organisational dysfunction include electoral misconduct, bullying, failures of governance and of financial oversight and the inadequate management of conflicts of interest reported recently in the national press. https://www.theage.com.au/national/claims-of-bullying-infighting-at-medical-college-with-toxic-culture-20180307-p4z37v.html
The RACP’s management and governance structures need investigation and reform if further disasters are to be prevented and the College’s core functions honoured once more.
Peter Brooks is Professor,Centre for Health Policy, Melbourne School of Population and Global Health. Ian Kerridge is Professor of Bioethics and Medicine,University of Sydney..