Performance in candidates declaring versus those not declaring dyslexia in a licensing clinical examination

High-stakes medical examinations seek to be fair to all candidates, including an increasing proportion of trainee doctors with specific learning differences. We aimed to investigate the performance of doctors declaring dyslexia in the clinical skills assessment (CSA), an objective structured clinical examination for licensing UK general practitioners.

We employed a cross-sectional design using performance and attribute data from candidates taking the CSA between 2010 and 2017. We compared candidates who declared dyslexia ('early' before their first attempt or 'late' after failing at least once) with those who did not, using multivariable negative binomial regression investigating the effect of declaring dyslexia on passing the CSA, accounting for relevant factors previously associated with performance, including number of attempts, initial score, sex, place of primary medical qualification and ethnicity.

Of 20 879 CSA candidates, 598 (2.9%) declared that they had dyslexia. Candidates declaring dyslexia were more likely to be male (47.3% versus 37.8%; p < 0.001) and to have a non-UK primary medical qualification (26.9% versus 22.4%; p < 0.01), but were no different in ethnicity compared with those who never declared dyslexia. Candidates who declared dyslexia late were significantly more likely to fail compared with those candidates who declared dyslexia early (40.6% versus 9.2%; p < 0.001) and were more likely to have a non-UK medical qualification (79.3% versus 15.6%; p < 0.001) or come from a minority ethnic group (84.9% versus 39.2%; p < 0.001). The chance of passing was lower for candidates declaring dyslexia compared to those who never declared dyslexia and lower in those declaring late (incident rate ratio [IRR], 0.82; 95% confidence interval [CI], 0.70-0.96) compared with those declaring early (IRR, 0.95; 95% CI, 0.93-0.97).

A small proportion of candidates declaring dyslexia were less likely to pass the CSA, particularly if dyslexia was declared late. Further investigation of potential causes and solutions is needed.