COVID-19: the cost of postponing college exams

SEVERE acute respiratory syndrome coronavirus 2 (SARS-CoV-2) cross-infection risk has understandably resulted in the postponement of forthcoming specialty exams of major colleges, such as the Royal Australasian College of Surgeons, the Royal Australasian College of Physicians and the Royal College of Pathologists of Australasia.

Examination postponements, while unavoidable, place burdens on the health system. Exam preparation is a long process, with senior and junior clinical staff committing significant time to helping candidates prepare for all aspects of the examination. Candidates themselves spend countless hours practising not only their clinical skills but also the specific approach to each examination, the mastery of which is an art in itself. Not all of this time is wasted by postponement, but there is no doubt that preparations will need to be repeated for a future examination, again reducing the contribution of junior staff and their supervisors and teachers to clinical care.

Health services need to plan accordingly. Some specialties tailor rotations to ensure those taking an examination can prepare in the best possible environment. The ability of health services to adapt rosters for a future date will vary, potentially advantaging and disadvantaging some candidates. Further, any postponement will have an impact on the completion of training of some candidates, delaying the entry of practitioners to independent clinical roles at a time when well trained clinicians are in short supply.

Most importantly, with an unclear duration of the SARS-CoV-2 pandemic, scheduling an examination for a later date will perpetuate uncertainty and alternatives must be considered. The UK acted quickly to allay anxiety when faced with a similar education assessment dilemma after the cancellation of their school General Certificate of Secondary Education (GCSE) examination (equivalent to the Australian Year 12 exams). The replacement is fair and reasonable, with candidates to be assessed on their in-school performance as well as performance in trial exams, and award of a commensurate qualification, with an option of sitting a modified examination later for those who believe their award to be unfair.

In medical settings, solutions can respect both the urgency of clinical loads and the integrity of professional standards. Considerations include modern technology as well as existing programmatic approaches. The former should be discussed but may be difficult to implement quickly. Nevertheless, written college exams can in fact proceed using computer-based administration with lockdown technology to enable so-called bring your own device electronic solutions. Also, remote, artificial intelligence-supported invigilation exists already and is being used in high-stakes certification assessment, such as state bar exams in the US. Conversely, assessments based on longitudinal collection and triangulation of information about a trainee’s performance and progress have been around for over a decade, and have actually been shown to lead to higher levels of competence when compared with single event examinations. These latter options could be implemented quickly and similarly to the UK GCSE approach.

Colleges have options to rapidly implement a just alternative assessment, and the SARS-CoV-2 pandemic may be seen as an opportunity to use contemporary and better processes. All colleges are required to incorporate ongoing assessments of their trainees, and a defensible approach can be applied using these past assessments as well as specific (and, reasonably, multiple) supervisor views regarding the adequacy of a candidate to pass.

Given the crisis situation, such approaches would now have to be retrofitted and, in some cases, may be complemented by specific task-based assessments in the clinical setting over a limited period (eg, 6 weeks). There are various relevant and successful examples described in the literature (here, and here). Further inputs may include consideration of past performance of individual centres and other methods of balancing limitations of using individual assessors.

Of course, there has been long debate as to the best assessment approach for college trainees. Although most would agree that longitudinal, continuous and even programmatic assessment would be favourable over the current system, the implementation of such systems is not always easy. We argue that these are exceptional times when we should both highlight and resolve the need for assessment processes that are sympathetic to health services under pressure and address the need for rapid innovations and improvements in training and assessment. A process to clarify the sequel to cancellation of college exams can and must be put in place quickly to ensure health services, clinicians, educators and, not least, the candidates themselves can plan with confidence in uncertain times.

Professor Geoffrey Thompson is an Adelaide-based paediatrician whose former roles include Chair of the SA Institute of Medical Education and Training, Deputy Chair of the Confederation of Postgraduate Medical Education Councils and Deputy Medical Editor, the Medical Journal of Australia.

Professor Lambert Schuwirth is Strategic Professor in Medical Education at Flinders University, Professor for Innovative Assessment at Maastricht University in the Netherlands and Adjunct Professor of Medicine at the Uniformed Services University in Bethersda, Maryland. He has extensive experience and publications in assessment of medical competence and performance in undergraduate and postgraduate training settings.

The statements or opinions expressed in this article reflect the views of the authors and do not represent the official policy of the AMA, the MJA or InSight+ unless so stated.