Article
A flawed examination
I read with interest your fervent comments regarding the announcement by the Royal College of Surgeons of Edinburgh and the reply of the Dean of the Dental Faculty to your Editorial in the April issue, regarding the dropping of the case presentations from the MOrth (Edin) examination.
I could not agree more with your comments regarding the reflection necessary from the candidates for the case presentations. This is the only section of the exam that follows the whole continuum of patient care from start to finish, and represents exactly, the practise of the specialist practitioner.
The response by the Dean of the Dental Faculty states that some competencies, including such cases, are best assessed using WPBA. However, the ARCP process does not presently do this. There is no national standardization of assessment, which is carried out internally, usually by the trainee's own trainers. The ISCP process monitors case numbers and case mix, but not necessarily the quality nor the understanding of the treatment carried out. It should also be remembered that MOrth is an international exam and candidates outside the UK do not have these processes in place. Is the College to accept only candidates from UK training programmes in the future?
The response states that there are sound educational reasons for the change, but to enhance these aims by dropping the case presentations entirely demonstrates a lack of understanding of orthodontics and the purpose of this section of the MOrth exam. This section is to test the candidates' understanding of the treatment and not the quality of the presentation itself, nor the quality of the result. The preparation of these cases certainly does not reduce the clinical activity of the candidate as is stated in the response.
When discussing the validity and reliability of a small sample of cases in this section, the very nature of the exam and the analysis of many more cases and the subsequent preparation of four, is misunderstood. It is not about the quality of the result, or the presentation, but about the understanding of the cases and mechanics used, and reflection upon how the results were achieved that are examined. This is brought out by the knowledge and experience of the examiner. If this section is considered not to be robust, there are workable ways of making it more so, rather than dispensing with it completely. Whatever the replacement will look like, it will not replicate the assessment of understanding and reflection highlighted presently.
It is unfortunate that without engaging the trainers and examiners, let alone the SAC, which has a responsibility for recommending assessments associated with specialty curricula, JCPTD and GDC, the changes mean that we now have a dichotomy between the two MOrth examinations and either of the differing exams being a requirement of UK trainees for entry on to the specialist list. Surely, such a position should have involved greater involvement from these interested parties and especially when there is a GDC curriculum review to be published in the near future. It is to this new curriculum that the MOrth examinations will need to be matched.
As a trainer and examiner for the RCS Edinburgh examination for over 30 years, I am deeply disappointed and troubled by this change. In my view, the exam is now flawed and, despite the arguments put forward in the College response, the MOrth exam may not fulfil the purpose of identifying the safe, independent specialist practitioner.