Reflections after MEQ and CEQ workshops - what is the value of a written exam for the RANZCP training program?

I'm heading home after delivering a successful round of face to face workshops for the MEQ and CEQ essay exams. 

I had trainees come to meet me in Queensland from so many places, including New Zealand, Tasmania, Adelaide, Far North Queensland, Sydney, the Gold Coast, Newcastle and Lismore. 

We delved into a solid strategy and approach for these high stakes exams but there was also a sharing of frustration and disappointment form many who who were facing a multiple attempt at the exams, with little feedback about past progress and coming so close in recent attempts. 

I lament the current situation whereby past clinical exams, the OSCE's and OCIs/OCA's have been replaced by written ones. I do believe after 17 years of coaching and training doctors for the RANZCP exams that this indeed is the way to put prospective consultants through their paces.

I am not a critic of the CEQ essay exam - basically a piece that is a candidates reflection or response to a quote that can be derived from a journal article, poem or book. I just don't see how it can now be such a high stakes exam, especially when there is no other assessment that helps teach trainees how to write essays. Essay writing and clinical psychiatry practice don't seem to share commonalities. And given our reliance on IMG's as essential participants in our workforce, I can see it can be pretty unfair as well. 

The MEQ essay exams examine clinical content as well as other important aspects of practice including advocacy, governance and leadership. But as a previous exam coach for the RANZCP OSCE exams and also a past examiner for the RANZCP OSCE's,  I feel that oral exams are a much better way to examine. 

It seems to me that the only reason we have lost our clinical exams is because they proved to be nearly impossible to run through the COVID-19 pandemic and associated lockdowns without IT problems that led to the exams falling over on the day. This was of great distress to many trainees who were part way through the exam when it occurred.

But I do feel after spending the past 4 days with written exam candidates, we are just replacing one form of distress with another. 

Now that the world has found a new normal, I do call for a discussion about whether we re-introduce clinical/oral exams and set aside the written exams, which are more cost effective to run, but don't necessarily select for the best doctors. 

I'd love to know whether you agree,

Helen