Re-examining single-moment-in-time high-stakes examinations in specialist training: A critical narrative review

Figures & data

Table 1. Arguments for and against the use of single-moment-in-time high-stakes examinations in specialist training.

For	Against
Familiar to assessors and learners	Inconsistently applied
Able to assess large content areas in a short amount of time	Poor evidence of validity
Provides evidence of accountability to regulators and public	Not explicitly required by regulators
Regarded as an objective measure of competence	Primarily used to assess knowledge, with unnecessary focus on minutiae
Drives learning	Oversimplifies complex nature of competence
Aids in establishing a professional identity	Learners focus on content required for passing at the expense of that required for competent practice
Possible safeguard against role substitution by non-medical health professionals	Emphasis on learning exam technique
Feasible for assessing those with non-recognised qualifications	Immediate recollection of detailed knowledge does not reflect contemporary clinical practice
Financial benefits for administering institutions	Detrimental effect on trainee well-being
	Punitive role in differential attainment
	Financially detrimental to trainees

Table 2. Potential revenue from international candidates sitting the MRCPUK SMITHSEx.

	International candidate fee (2023)	Number of attempts in 2019^a	Potential revenue
Part 1 (written)	£616	7478	£4,606,448
Part 2 (written)	£616	3476	£2,141,216
PACES (clinical)	£1202	4137	£4,972,674

^aFigures are for candidate attempts by non-UK trainees, not number of candidates (Royal Colleges of Physicians of the United Kingdom 2019b, 2019c, 2019a). Candidates self-declared if they were UK trainees or otherwise.

Royal Colleges of Physicians of the United Kingdom. 2019b. Part 1 2019 annual performance report. https://www.mrcpuk.org/document/part-1-2019-annual-performance-report.

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Royal Colleges of Physicians of the United Kingdom. 2019c. Part 2 2019 annual performance report. https://www.mrcpuk.org/document/part-2-2019-annual-performance-report.

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Royal Colleges of Physicians of the United Kingdom. 2019a. PACES 2019 annual performance report. https://www.mrcpuk.org/document/paces-2019-annual-performance-report.

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