Assessment and management of delayed examination progress
In medical training, unsuccessful attempts in mandatory examinations are a common reason for delayed progress in training. Examination failure is stressful for doctors as there are potentially high stakes of longer time in, or release from, training. Examination failure can also be expensive for NHS Education for Scotland when training time needs to be extended. It is commonly assumed that as all doctors have passed many examinations at undergraduate level, they must be skilled in study and examination techniques. However, for many trainees this will be the first experience of balancing study with a busy and demanding job. Previously successful study methods may have become inadequate and examination more demanding and requiring of deeper knowledge and more critical thinking. Many exam issues will be remediable with support from the local training team and relate to lack of preparation or poor study technique and focus. Some trainees may also struggle with exams due to issues such as situation specific or general anxiety, dyslexia, dyspraxia, or memory disorder. It is not uncommon for a suspicion of a neurodivergent condition such as dyslexia or ADHD to become apparent for the first time at this stage.
Next steps after unsuccessful examination attempt
First attempt – Doctors in training should arrange a meeting with their Educational Supervisor to discuss the reasons for the failure and to establish a path forward. Educational Supervisors may wish to refer to this helpful checklist for conducting post-exam failure review meetings.
Two or more unsuccessful attempts – Two or more consecutive unsuccessful attempts at the same exam, should prompt consideration of the possibility of an undetected neurodivergent condition such as dyslexia.
If there are concerns that wellbeing, health, or neurodivergent conditions may be contributing to exam failure, we encourage seeking a referral to the TDWS for support.
Consider undiagnosed dyslexia
To assist doctors in identifying whether dyslexia may be a factor impacting upon their training, we recommend doctors undertake a self-funded screening assessment through Dyslexia Scotland
Where the screening report suggests borderline or positive indicators of underlying dyslexia, a full assessment should be requested by the doctor or the referrer by submitting a Contact Us form and sending a copy of the initial report to tdws@nes.scot.nhs.uk. We will then refer the doctor for a funded assessment which may result in a formal diagnosis and aid recommendations for reasonable adjustments both in future examination sittings and the workplace.
Reasonable adjustments for exams
Doctors in training with disabilities or neurodivergent conditions are eligible for reasonable adjustments when sitting exams. While each royal college or faculty has its own guidelines, common adjustments include:
Each request is carefully evaluated on a case-by-case basis to ensure that appropriate support is provided, maintaining fairness and accessibility throughout the examination process.
Exam support and ARCP progression
While referral to the TDWS is not mandatory for individuals receiving a developmental outcome at their ARCP review, we strongly encourage such referrals in specific circumstances. For instance, individuals experiencing difficulties at critical progression points or those facing ARCP outcome 4, and at risk of being released from training, should consider seeking support from TDWS to address developmental needs and ensure wellbeing.
Referrals are particularly encouraged when additional support or accommodations are necessary due to factors such as wellbeing, health issues, or neurodivergent conditions impacting training or exam performance.
Useful Resources:
Principles of exam preparation The Academy of Medical Royal colleges has published guidance to support individuals after exam failure. Guidance for trainers is on page 4. Going through this with your doctor in training can provide structure and identify areas of focus before their next attempt.
Principles for nullifying exam attempts and the provision of additional exam attempts to a candidate These principles ensure fair and equitable examination practices.
Managing Access Arrangements for Candidates requesting adjustments in High Stakes Assessments Colleges and Faculties have a responsibility to make reasonable adjustments to help disabled candidates overcome disadvantages in assessments. These reasonable adjustments can be applied to any aspect of the assessment process, except for the core competence standards.
This page was last updated on: 22.07.2024 at 20.24
