Hundreds of trainee physicians who were told an exam they must pass to be eligible for specialist training would be deferred until 2021 due to Covid-19 are distressed after the Royal Australasian College of Physicians said on Monday the exam will in fact be held in about three months’ time.
The decision will affect around 700-800 physician trainees in Australia and around 100 in New Zealand who are eligible to sit the exam, which involves a written and clinical component.
Doctors are limited to three opportunities to pass the exam, which attracts a fee of $2,972, and must do so within a timeframe dependent on their level of training. If they do not pass they are ineligible for progression to becoming a specialist doctor.
Trainees were informed by the college of the decision during a webinar on Monday night.
“This announcement has obviously caused a great deal of stress among physician trainees in Victoria,” one trainee told Guardian Australia. “The examination itself is a barrier exam to progress on to specialty training and our failing it worsens an already significant bottleneck on the specialty training pathways. We have three months of notice for this exam for which we literally cannot prepare without putting patients at risk, however we are put in a position where our jobs are at risk if we do not prepare.”
Ordinarily, the exam would involve going into clinical settings such as hospitals and examining patients, but sending trainees into hospitals unnecessarily could heighten the risk of transmitting Covid-19. In the chatroom during the webinar, one trainee wrote: “Given that we were prematurely disarmed by being told, in writing, the clinical exam would be held no sooner than 2021, and we now have to prepare for an unexpected change to this, will there be any change to the marking scheme or the fees?”
Another wrote: “A key consideration here is our physical ability to prepare for the exam. Workloads have significantly increased in Victoria … This needs to be acknowledged please.” Three months to prepare for an exam was “unfathomable”, another wrote. “Our hospitals are extremely busy, we are working overtime for staff off-sick or in quarantine. Victorian [trainees] are extremely disadvantaged compared to other states.”
One trainee felt that college representatives “had no intention of taking into consideration our concerns as trainees and doctors”.
But the chair of the college’s adult medicine clinical examination committee, Dr Elizabeth Whiting, said the change was made following requests from trainees and supervisors in states with no community transmission for the clinical exam to be held as soon as possible.
“It’s also important we don’t add to the workload of already busy hospitals, so we’ve decided to split the exam in two and run the first part virtually, utilising phone or video conferencing,” she said. “We are planning to run the first part of the exam between November 2020 and January 2021 with the second, face-to-face component, in February-March 2021. The situation in Victoria has unfortunately rapidly escalated and we are monitoring it closely to see how we can best support our trainees, supervisors and examiners there.”
The Australian Medical Association’s council of doctors in training deputy co-chair, Dr Rebecca Wood, said that while she sympathised with the college it must take the anxiety and distress of trainees into consideration and introduce measures to support them.
“The college only holds one exam per year unlike many other colleges which run two exams a year, which takes pressure off,” she said. “We would really hope the college is considering taking a non-punitive approach in the time of Covid.” This meant not counting the next exam as one of the three failed attempts if students did not pass, Wood said.
In a statement the council said trainees’ representatives had reiterated that exam readiness and preparation had been significantly impacted by the response to the pandemic.
“We understand the workforce pressures at this time and everyone’s desire to see trainees progress through training,” the statement said. “The move by the college to pursue the long case portion of the clinical exam is an admirable move to progress trainees through the exam process.
“However, we need to be cognisant of how this interacts with the current pandemic environment, particularly in Victoria where the number of cases has grown. Innovative approaches to progression through training are encouraged to counteract any opportunity loss for exam attempts, time lost, and to maintain throughput through the training pipeline and into fellowship.”
Wood said effective communication would prove vital and that she expected better consultation with the trainee committee moving forward. “It is in no one’s best interests – trainees, supervisors, hospitals and patients – to set trainees up to fail in the current uncertain environment,” the council said.
“The AMA encourages improved clarity and transparency of communications with trainees, particularly around decision-making processes, examination timelines, options for progression through training, whether failed exam attempts during Covid-19 will count towards maximum examination attempts, whether extended or interrupted training during Covid-9 will count towards maximum training time, avenues for further discussion of personal circumstances, and jurisdictional decision-making processes regarding access to examination leave and professional development leave in the lead-up to postponed portions of examinations.”