RCSEd President Professor Clare McNaught reflects on her memorable experience examining in Yangon, Myanmar, in 2016, comparing the old MRCS format with the introduction of the OSCE. She also explores the ongoing review of MRCS examinations and how changes will support fairer, more standardised assessments.
One of the most memorable moments in my life as an examiner was a trip to Yangon, Myanmar in 2016. I had only recently joined the College in this role and was delighted to be asked to travel to this magical part of Asia. During this visit, we ran a diet of the ‘old format’ MRCS, to clear the backlog of candidates who had started in the previous system. The following day, we then ran the new OSCE style exam, which is almost identical to what we have now.
For those who do not recall the old exam, the clinical part was much more like an exit FRCS, where the examiner was presented with a room full of various patients with different clinical conditions, and we asked questions as we saw fit. There was some general guidance around marking, but certainly not the structured Q&A that we have now. I remember vividly, walking into an old, colonial style building with nightingale wards surrounded by open verandas which overlooked the green central atrium. The nurses wore white starched pinafores and hats over their pristine uniforms, and I felt that I had been transported back in time.
The patients were delightful, but their disease processes were often advanced, reflecting the great distances many had to travel to obtain care and the limited healthcare resources in the country. It was as if someone had opened the Bailey and Love textbook. I saw Burkitt’s lymphomas of the neck that were larger than a football, Potts fractures of the spine, discharging osteomyelitis with Marjolin’s ulcers and a child with Volkmann’s ischaemic contracture. The young surgeons were incredibly knowledgeable and well prepared, and I think I passed each one of them.
On the following day, we did the first OSCE exam. In the previous year, two teams had been out to run preparation courses to ensure that the local examiners and candidates knew what the new assessment involved. Once again, all the candidates were superb. Delivering the different examinations back-to-back did allow me to directly compare them. Although the old style was possibly more interesting for the examiner, as you actually had to know information about the generality of surgery and not just your own specialty, there was no doubt in my mind that the new exam was fairer, more standardised and less open to bias. I remember at the time that there was considerable unrest in the examiner faculty that the new exam was not as good. But here we are, many years on and the MRCS is as popular and well respected as ever.
At the present time, the MRCS exam process is undergoing a review. The GMC have asked all Colleges to ensure their examinations minimize the examination burden on trainees and address the issue of differential attainment of candidates based on their protected characteristics. This review is ongoing, and there will be a few new changes in the format, which reflect best practice and evidence in educational assessment science. Change is always difficult, and often associated with suspicion and disquiet, but all the Colleges, and many other stakeholders, have been actively involved in this process and I am content that the new format will achieve the aims set out by the GMC. For us as examiners, I suspect we will not notice much difference. The marking schedules will be altered a little, the clinical scenarios will be updated to incorporate anatomy into them and the technical skills stations will be improved, but we will still assess 40 candidates per day as we do now.
Sadly, we have not been able to return to examine in Myanmar due to the political circumstances there, but I have enjoyed this walk down memory lane and will always have a special place in my heart for the people and patients of Yangon.