The low pass rate in the RANZCP clinical examinations: is the exam the problem?

The aim of this study was to examine the role of supervision during psychiatric training in ensuring that registrars are adequately trained to meet the standards of the RANZCP examinations and to consider the implications for improving examination pass rates.

Audiotaped recordings of 50 h of supervision involving six supervisors and thirteen trainees, obtained 2000-2003, were transcribed and analysed thematically in a qualitative study, informed by a postmodern, foucaultian perspective.

Until an examination loomed, supervisors rarely required evidence of theoretical study or structured case presentations from their trainees. The examination and the examiners served to justify the supervisors requiring such discipline. This enabled the supervisors to remain in a supportive role, while requiring higher standards from trainees. Paradoxically, while requiring higher standards 'for the exam', trainees were told that the examiners expected nothing more than 'good psychiatric practice'. In presenting cases, the attributes of prioritization, thoughtfulness, conciseness and good timing were valued, as reported in both undergraduate and other postgraduate medical training.

Much of supervision bore little relationship to preparation for college examinations until these were imminent. While the daily practice of trainees and supervisors continues to be at variance with the practices required to pass the examination (reflected by reference to 'exam-style' and 'non-exam style' presentations) the pass rates will remain low. If we believe that the standard set in the examination is that required of a practising psychiatrist, change is required to supervision and daily practice standards to reflect these standards.