Performance of candidates declaring dyslexia in the MRCGP clinical skills assessment: cross sectional study

Problem

There are increasing numbers of doctors each year who declare dyslexia when they take the Membership of the Royal College of General Practitioners (MRCGP) licensing exam for general practice. Exam bodies seek to be fair to candidates with disabilities such as dyslexia as part of their Public Sector Equality Duty under the Equality Act 2010. We aimed to investigate performance of doctors declaring dyslexia in an Objective Structured Clinical Examination (OSCE), the Clinical Skills Assessment (CSA) component of the MRCGP.

Approach

We used a cross-sectional design, analysing routine candidate performance and demographic data from the MRCGP CSA between 2010 and 2017. We used multivariable logistic regression, comparing candidates who declared dyslexia (either ‘early’ before their first attempt, or ‘late’ after failing at least once) with candidates who did not declare dyslexia, to investigate the effect of declaring dyslexia on passing the CSA taking into account number of attempts, together with sex, place of primary medical qualification and ethnicity.

Findings

Overall, 20879 candidates took the CSA between 2010 and 2017 of which 598 (2.9%) declared dyslexia. Candidates declaring dyslexia were no different in ethnicity compared with those who did not declare dyslexia but were significantly more likely to be male (47.3% vs 37.8%; p<0.001) and to have a non-UK primary medical qualification (27.0% vs 22.4%; p=0.001). Candidates who declared dyslexia late were significantly more likely to fail the CSA compared with those candidates who declared early (40.6% vs 9.2%; p<0.001). They were also more likely to have a non-UK medical qualification (79.3% vs 15.7%; p<0.001) or come from a minority ethnic group (84.9% vs 39.2%; p<0.001). Candidates who declared dyslexia were significantly less likely to pass the CSA compared to candidates who did not declare dyslexia, particularly when this was declared late (Incident Rate Ratio [IRR] 0.78, 95%; Confidence Interval [CI] 0.67 to 0.91) but also when declared early (IRR 0.94 95%; CI] 0.92 to 0.97).

Consequences

This is the first published study, to our knowledge, investigating the performance of doctors with dyslexia in OSCEs for high-stakes licensing purposes. Trainees declaring dyslexia, and particularly declared late, were less likely to pass the CSA. We found that doctors from minority ethnic backgrounds and those who had received their primary medical qualification outside the UK were more likely to declare dyslexia after initially failing the assessment, and this delay in diagnosis (reducing the possibility of additional preparation strategies) or declaration (decreasing access to reasonable adjustments) may disadvantage these candidates. Differential attainment in doctors with dyslexia needs to be addressed by investigating potential causes and finding solutions for such disparities as well as facilitating earlier assessment of dyslexia in those not previously diagnosed, particularly ethnic minority non-UK trained doctors.