The present day: MRCP(UK)

The Federation, through the Joint Royal Colleges of Physicians Training Board (JRCPTB), now has responsibility and ownership of the curriculum, and the MRCP(UK) as a part of the assessment system has been obliged to demonstrate that it meets the standards of quality and governance now required by the General Medical Council (GMC).

A co-ordinated strategy for the MRCP(UK) Diploma Examinations was first set out in 2007 and designed to be delivered over five years. It will ensure that the reputation of the UK Royal Colleges of Physicians in the assessment of trainees is enhanced and that the high quality of the examinations is not jeopardised.

As an external regulator, one of the GMC’s goals is to guarantee the standardisation of all assessment processes.

One of MRCP(UK)’s key developments has been the introduction of test equating, which standardises the difficulty of the written examinations paper by paper. This important quality assurance process has been developed with psychometric support from the National Board of Medical Examiners based in Philadelphia and ensures that the level of difficulty of successive papers can be compared.

Similarly, the revision of the PACES Examination was approved with the recommendation that we also develop quality assurance processes which ensure the standardisation of assessment delivery and test stringency across all centres.

Keeping up quality is not just a matter of ensuring that academic standards of consistency and reliability are met. Appropriate selection methods and adequate training for assessors have to be demonstrated and there must be lay involvement in the assessment process. MRCP(UK) is now fortunate to have the input of five lay representatives.

Rightly we are obliged to demonstrate transparency and, with this in mind, all the appropriate information for trainees is web-based. Each candidate worldwide is now given prompt feedback with a breakdown on performance and marks scored.

Mapping to a curriculum

The board officers for both MRCP(UK) written examinations have completed the manual analysis of paper content and it is reassuring that there was more than adequate coverage of core knowledge and the ‘top 20’ presentations listed in the curriculum.

In the future, these checks will be achieved on a regular basis with the help of a new question bank. This will have the added advantage that the examinations can be delivered by computer. Computer-based testing in the diploma examinations will become the norm. This format has the added value of reducing the risks of academic misconduct by collusion or copying.

The future

In 2007 the Postgraduate Medical Education and Training Board approved ‘The Physician of Tomorrow’, the curriculum for General Internal Medicine (Acute Medicine) submitted by the JRCPTB. To ensure that all examinations are mapped to the respective curriculum, MRCP(UK) will continue to work closely with the GMC in the forum of the Academy Assessment Committee.

In 2008 MRCP(UK) was responsible for a question bank of around 12,000 questions, with four examination boards setting eleven papers. In 2009 the Specialist Certificate Examinations added a further 10,000 questions and there were 12 exam boards. A total of 35 exam papers will be set from 2010 onwards.

The future demands a process of continuous evolution of assessment methodology in all parts of the MRCP(UK) examination. This must be accompanied by the introduction of further measures to demonstrate comprehensive sampling of changing curricula, updated as medicine advances.