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Chris Williams rightly identifies case selection as a fourth factor in the assessment of RCA candidates, in addition to data-gathering, clinical management, and interpersonal skills. He questions whether the ability to submit suitable cases is ‘really a prerequisite for safe independent general practice’, and implies that this requirement is underhand and unfair. It is neither.
The exam regulations make it clear that the onus is on candidates to submit evidence that they are competent to manage the whole range of problems they may face in unsupervised practice. As a patient, I would have no confidence in a process that could certify a doctor’s competence on the basis that he or she could satisfactorily manage a straightforward case of otitis media. It may well be that some candidates are disadvantaged by their background or by the demographics of their training practices. But which is more important – to overlook doctors’ weaknesses or to keep patients safe? I don’t want to be treated by someone who thinks otitis media is a difficult challenge.
Dr Williams asks, ‘Can the level of challenge of a GP consultation even be judged reliably?’ Certainly it can. The assessment of any complex skill where competence cannot be reduced to a checklist of objective ‘yes-no’ items, such as general practice, ultimately relies on carefully selected, well-trained and rigorously monitored judges exercising their...
Competing Interests: None declared.