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Page 38 | Bulletin 93 | September 2015 and the pass rate by its central-point position along the y-axis. The summary conclusions from the GMC study equally reflect our findings which are that: ■■ Doctors who were in a UK training programme when taking the exam were more likely to pass than those who were not. ■■ Women were more likely to pass than men. ■■ BME doctors from a UK medical school were less likely to pass than white doctors from a UK medical school. Pass rates were 55.3% and 69.3% respectively for anaesthesia. ■■ BME doctors from a UK medical school were more likely to pass than white doctors from a non-UK medical school. Everyone agrees that these results arise because of a complex multitude of influences. Dr Lumb concluded that ‘Our demonstration of no significant differences in the relative performance of the various groups between different exam components provides a modicum of reassurance that the causes of the differential pass rates are unlikely to include examiner bias, but a more comprehensive study is needed.’ The ERG therefore suggested that the RCoA must ensure that its database is of a sufficiently high standard to allow longitudinal studies of large enough numbers in the future, that this type of study should form part of future reviews, and that groups who are shown to have specific problems with the exam should be given guidance as to how those areas of their examination technique (and clinical practice if relevant) may be improved. Ideally gender and ethnicity of the examining board should mirror those of the candidate pool to minimise any conscious or unconscious bias but, as there is a minimum delay of 8-12 years between taking the exam and being appointed as an examiner, this is unrealistic. The comparator should therefore be the workforce, and although the snapshot of the exam boards presented below does not reflect that, we are confident it is changing without the need for any affirmative action. Primary Board: 82 Examiners. 59 Male, 23 Female (28%), 72 White/ European, 10 BME (12%). Final Board: 66 Examiners. 47 male, 19 Female (29%), 51 White/European, 15 BME (23%). Lay involvement Lay involvement in medical examinations is specified in the GMC’s standards for curricula and assessments, and the RCoA has a wellestablished Lay Committee (LC) which represents the patient’s perspective. LC members visit the examinations, provide feedback, and sit on the Examinations Committee and ERG. Although they are keen to be more involved in examining, their conclusion in the ERG was that they lacked sufficient personnel with enough time to be trained for greater participation. Because of their observation that a recurring concern was the ability or otherwise of anaesthetists to communicate effectively with their patients, they proposed to focus their involvement on input to the testing of history taking and communication skills. Technology and Computer Based Testing (CBT) The ERG recommended that the use of technology be explored in the following areas: 1 Computer testing kiosks in the Primary OSCE, and e-marking the OSCE and possibly the SOE. The Primary MCQ will be the first exam modified to a CBT format (3 year target). 2 Once developed, the CR paper in the final will be modified to a CBT format so that all the written Final will become computerised (6 year target). 3 Once written papers are all computerised, the role of examination centres as opposed to venues organised by the college will be explored. Acknowledgements My thanks to all members of the committee who ensured that decisions were taken after well considered and frank discussions. Special thanks to the Examinations Department who provided the necessary background information and their experience to inform those discussions, and who form the backbone to the entire examinations process. References 1 Brenan L, Lumb A. Differential pass rates in the FRCA. RCoA Bulletin 2015:92:29-31.
Page 39 | Bulletin 93 | September 2015 Evolving AACs ‘Helping employers appoint the right doctor for the right post and to develop a reliable, fair and transparent process for applicants’ Andy Norris RCoA Lead AAC Assessor Around 400 consultant colleagues act as assessors for Advisory Appointment Committees (AACs). In the May Bulletin this year Mr Charlie McLaughlan’s article ‘What is an AAC?’ outlined how the College is developing this aspect of its work. One of the initiatives described was the creation of a new College appointment, that of Lead AAC Assessor. I was later appointed to this role and, as an assessor for around 10 years and a former Regional Advisor, I am aware of the difficulties we assessors can have, but also the potential the College has through ourselves to help employers make the best appointments. The presence of a College assessor at AACs was formerly a universal requirement and, although it is no longer mandatory for Foundation Trusts, the majority do still request our involvement. It is mine and the College’s intention that this engagement is not seen, as a tick-box exercise with which employers can say they have complied, but increasingly as a valuable service. What value does the external assessor bring and how can it be enhanced? The May article made the point that strong appointments are crucial to patient safety. As a minimum, the external assessor is seen as a content expert who can verify that the candidates are qualified for the post. Added value depends on the AAC Chair, the custom of the employing trust, as well as the assessor. We might be forgiven for thinking that the advent of competency-based training and certification nullified the need for external endorsement of a candidate. This is an unfortunate and widespread misconception. The award of a CCT in itself provides reassurance (compared to the substantial variation that occurred in training previously) that an appropriately comprehensive programme has been successfully completed. The external assessor as an experienced consultant in a relevant field is able, and should be empowered by the Chair, to make an assessment of the candidate’s strengths relative to peers across the country and over time. In addition to the reassurance this can provide, there is also the more general opportunity as a community of assessors to publicise and disseminate best practice in all areas of consultant appointments. These areas range from communication of intention to appoint, post approvals, advertising, writing job descriptions and person specifications, through to interview formats, briefings, interview conduct and post interview deliberations. The Clinical Quality Directorate is keen to work not only with its assessors but also with HR departments and Clinical Directors so that lessons can be learned and good practice shared. Priorities and first steps One of our first tasks is to improve our understanding of the wide variation in current practice of AACs and the ways in which the knowledge and experience of our assessors contributes. The College especially wishes to identify assessors’ concerns and provide whatever support and training is possible. A short survey of our assessors will be underway by the time this article appears in print, and the results of this will be key to deciding some of the priorities. One such priority is the need for adequate notice in requesting an assessor. The continued pressure on job plans and rotas has made the issue of inadequate advance notice ever more difficult. The College constantly reinforces this message, but we need to still be more effective. We can all play some part in this. Consultant appointments do not come as a surprise to hospitals and departments, so if you are aware of impending appointments make it your business to ask if the College has been approached. I am also very conscious that many assessors have great difficulty in being reimbursed
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