The clinical examination for the MRCPCH is a major hurdle that every aspiring paediatrician has to face in their career. As the exam is designed to differentiate between the prepared and unprepared candidates, it is important to be well trained. To pass the MRCPCH exam, the candidate needs to demonstrate that they have the clinical skills expected of a newly appointed specialist registrar. According to the Royal College of Paediatrics and Child Health, the aim of the examination is to ‘improve the standard of medical care, educate and examine doctors and provide information to the public on the health care of children’. Competence is expected in various aspects of paediatric medicine, including history taking, communication, establishment of rapport, physical examination, clinical judgement, professional behaviour, and ethical practice. On the Royal College of Paediatrics and Child Health website, www.rcpch.ac.uk, a lot of information is provided for candidates. Every candidate is encouraged to visit this website before sitting the exam. Conventionally, the MRCPCH clinical exam consisted of a long case, a short cases, and a viva. However, concerns were raised about the validity of the traditional system, as it focused mainly on knowledge rather than competence. According to George Miller, who proposed a pyramidal framework for assessing clinical competence, the lowest level of the pyramid of assessment is the evaluation of knowledge. This is tested by written examinations. At the second level, the assessment tests not only the theoretical knowledge but also the application of this knowledge. At the third level, the individual has knowledge, knows how to do it, and shows how it is done. This is the level of ‘true competence’ and the MRCPCH clinical examination tests at this level (figure 1.1). In 2004, a major change was brought about in the clinical examination, in which competency-based ‘objective structured clinical examination’ replaced the traditional system. In the new MRCPCH clinical examination, the candidate goes through a ‘circuit’ of clinical stations. Competency-based assessments provide a measure of the subject’s skills in controlled representations of clinical practice and are regarded by both candidates and examiners as a fairer evaluation method. Candidates are given instructions either by the examiner or in written format with a predetermined ‘opening statement’.
Specialist registrar training: at the crossroads (again)