Reducing the attainment gap: evaluating the impact of the Royal College of Psychiatrists CASC examination masterclasses

Background
The UK medical workforce is becoming increasingly diverse, with the number of International Medical Graduates (IMGs) increasing by 40% over the last 5 years. Research has identified significant barriers that that IMGs and UK ethnic minority trainees face in their postgraduate medical training, including a lack of familiarity with UK assessments, and a lack of good quality feedback. The impact of these barriers can be seen in attainment gap observed in postgraduate examination pass rates.

Summary of work
This evaluation focused on eight Masterclasses designed by the Royal College of Psychiatry, and commissioned by the General Medical Council and Health Education England. These were designed to provide targeted support for trainee groups identified as being at higher risk of failing to progress in training, and focused on teaching trainees key principles relating to the CASC examination. 27 semi-structured interviews with participants explored the impact of the sessions.

Summary of results
Through thematic framework analysis, three key themes were identified: 1) raised awareness of key factors relating to the examination; 2) development of skills related to examination preparation and performance; 3) application of skills that impacted on examination preparation and performance.
Three key enablers were identified: 1) Expert facilitation; 2) Current examiners as facilitators; 3) Organisation.

Discussion and conclusion
Participants reported a raised awareness of the CASC examination requirements, and developed some key generalisable examination skills. They particularly valued that the Masterclasses were facilitated by current CASC examiners to give detailed, more focused and relevant feedback in what was perceived to be a safe and trusted learning environment. Trainees were not always fully aware of examination preparation resources already provided online.

Take home messages
Interventions can be developed to provide early, targeted support to trainees. There needs to be balance between familiarisation of the examination itself and the development of more generalisable skills. If trainees are targeted, this creates concerns around equity of opportunity that ‘high-value’ interventions are offered to only a limited group of trainees. A way of addressing inclusivity is to ensure all trainees are aware and are accessing and accurate information about clinical examinations.