Dyslexia associated with reduced pass rates in MRCGP Clinical Skills Exam but not Applied Knowledge Test

A recent study from a team at CaHRU and the RCGP, published in Medical Education, ‘Performance in candidates declaring vs not declaring dyslexia in a licensing clinical exam’ showed that trainee doctors with dyslexia were less likely to pass the clinical skills assessment, a component of the licensing exam for general practice. This contrasted with an earlier study which showed that doctors were no less likely to pass the computer based Applied Knowledge Test. The Clinical Skills Assessment (CSA) is an objective structured clinical exam (OSCE) which tests a doctor’s ability to gather information, make evidence-based decisions, and communicate effectively with patients and colleagues.

The study was led by researchers from the Community and Health Research Unit (CaHRU in collaboration with a team from the RCGP, and examined pass rates of 20,879 candidates who had taken the exam from 2010 to 2017 of whom 598 declared dyslexia. Findings showed that once other factors linked to exam success such as number of exams sat, initial pass mark, dyslexia, sex, ethnicity and country of primary medical qualification were taken into account, those who declared dyslexia were less likely to pass, and fared even worse if declaring dyslexia was delayed after failing at least once.


Interestingly, the findings of the study, which is the first to examine pass rates in the CSA, differ from a previous study of the Applied Knowledge Test (AKT), a multiple choice component of the MRCGP, found that dyslexia did not reduce pass rates for those declaring their learning difficulty prior to taking their exams. The study also found that candidates who declared dyslexia were more likely to be male (47.3 per cent compared with 37.8 per cent of females) and more likely to have gained their primary medical qualification outside the UK. Once other factors were taken into account, sex was not shown to have an effect on pass rates and trainee doctors from minority ethnic backgrounds were no less likely to pass than white British or Irish candidates. The study has highlighted the need for further research into the aspects of the CSA exam that candidates with dyslexia find more difficult and how these challenges could be addressed to better support candidates. A podcast of Prof Niro Siriwardena discussing the study and its implications with Medical Educations’ editor, Prof Kevin Eva, is also available.

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