Specific learning difficulties (SpLDs) differently affect performance on written compared to clinical general practice licensing tests: cohort study

Problem

Specific Learning Difficulties (SpLDs) affect the way information is learned and processed and can have a significant impact on learning and education. Substantial numbers of students who have a disclosed SpLD enrol in medical and GP training, but failure to accommodate their needs can disadvantage them in academic, clinical, and examination settings. Examination bodies have a legal obligation to provide equality of opportunity and eliminate unlawful discrimination.

The aim of this study was to evaluate and compare performance of SpLD candidates and candidates with no declared disability on all three licensing examinations, the Applied Knowledge Test (AKT), Clinical Skills Assessment (CSA) or Recorded Consultation Assessment (RCA), whilst adjusting for demographic factors including ethnicity, place of primary medical qualification, and gender as well as for prior attainment on the Multi-Specialty Recruitment Assessment (MSRA) test for selection to GP training.

Approach

We used a longitudinal design linking selection, licensing and demographic data from UK doctors entering GP specialty training in 2016. MSRA records from 2016 and 2017 were linked with their AKT (Applied Knowledge Test), CSA (Clinical Skills Assessment), and RCA (Recorded Consultation Assessment) outcomes up to 2021. Descriptive statistics included percentages of candidates taking and passing each assessment and average scores obtained on the licensing tests subdomains. Multivariable logistic regression models adjusting for gender, ethnicity, country of graduation, and MSRA scores established differences in the likelihood of passing each of the licensing tests between those with declared SpLDs and those without.

Findings

Out of a total of 2070 of candidates who undertook the AKT, CSA, and/or RCA, 214 (10.34%) had a declared SpLD. Overall, candidates who declared a SpLD had lower pass rates on all assessments, but these were statistically significant only for the CSA (no SpLD: 92.34% versus SpLD: 79.88%, z=4.59, p<0.001). Candidates declaring an SpLD were significantly less likely to pass the CSA (OR 0.43, 95% CI 0.26, 0.71, p=0.001), but not the AKT (OR 0.96, 95% CI 0.44, 2.09, p=0.913) or RCA (OR 0.81, 95% CI 0.35, 1.85, p=0.615). When looking at licensing tests sub-domains, SpLD candidates performed significantly worse on the CSA Interpersonal Skills (B=-0.70, 95% CI -1.2, -0.19, p=0.007) and the RCA Clinical Management Skills (B=-1.68, 95% CI -3.24, -0.13, p=0.034). This study confirmed that having a declared SpLD was predictive of poorer performance on the CSA, but not the AKT.

Consequences

Candidates with declared SpLDs may encounter difficulties in both applied knowledge and clinical skills licensing tests. Reasonable adjustments in place for them to overcome possible difficulties encountered in the applied knowledge test are sufficient, but further adjustments, tailored to their needs, are required for clinical skills tests (CSA and RCA).