EmergencyPedia

An Open Letter to the College

As the new format FACEM exit exam is in the process of being marked, there is now an opportunity to draw to the attention of the College, it’s officers and examiners to significant issues which have already adversely affected a considerable number of trainees and will no doubt continue to do so as the marks are released. The opinions forwarded in this letter have the broad support and agreement of many of my colleagues who have been preparing for the 2015.1 exam, many of whom expressed a marked reservation about voicing their concerns, fearful of reprisals from the College. I believe such fears are unfounded and trust that the College will be genuinely interested in the experience of candidates and seek to resolve the issues raised herein, before exposing candidates to the second exam in the new format.

There is phrase, originally coined by the British army, that has subsequently made its way into civilian use and will, no doubt, be recognised by many non-military personnel. The more polite version of this phrase is Proper Planning and Preparation Prevents Pretty Poor Performance, which is often shortened to “The Seven P’s”, but I much prefer the version which describes Piss Poor Performance – so much more evocative, don’t you think! The use of this particular military phrase has its roots among the litany of disastrous campaigns and planning errors that haunt our past and directly contributed to heavy loss of life. It is intended as an aide memoire in the hope of avoiding future catastrophes by prompting planners of all things to stop, think and actively avoid the avoidable. With respect to new iteration of the FACEM exit exam, it would appear that the Australasian College of Emergency Medicine has disregarded this wise military adage, much to the disadvantage of its own trainees who will form the future of the College.

Before proceeding, I would like to clarify that I fully support the efforts of the College to improve the structure of the FACEM examination and anticipate that the new format will continue to improve the quality of training. The change itself is not the cause my complaint. Where my argument with the College begins and ends is the shoddy and amateurish implementation process that we, as candidates, have been exposed to in recent months and it is the implementation of the current format that is unfair, unjust and unreasonable.

The build up to the exam was, quite frankly, a debacle of misinformation and misdirection with little in the way of effective engagement of candidates. I am struggling to express the immense frustration that was experienced as a succession of well-meaning and honourably intentioned specialists attempted to advise on an optimum approach to the exam, only for them to acknowledge that they don’t really know what was actually expected and are only using their best educated guess.

That poor state of affairs was compounded by the oft contradicting advice given by other specialists. Effectively, the College appeared to be keeping their very own specialists in the dark about the new exam format. How can a professional college conducting a specialist examination process possible justify such a level of disregard to their future specialists?

The promised release of example questions never happened – a couple of MCQ’s, a smattering of EMQ’s and a handful of SCQ’s with minimal marking criteria that the College provided on the website was a pathetic effort and, to be honest, a complete aste of bandwidth to download. The mantle of secrecy that the College maintained over the nature of the new exam was reminiscent of playground tittle tattle and actually compromises the professional integrity of the College.

There seemed to be a constantly changing approach as to how the exam was going to be assessed and marked, leading to the feeling of uncertainty amongst candidates. Changes were still occurring to the exam process literally in the final few days before the exam was to be held and this manner of approach led to confusion, anxiety and uncertainty, all of which had a direct and negative impact on candidate’s preparation.

The MCQ exam in the morning was conducted through computers, a very reasonable and sensible approach, but the start of the exam was the very first time any of the candidates had seen the software. In addition to the anxiety and mental energy of answering the actual questions, a proportion of that energy would have been dedicated to working out how to use the software. This approach was completely inconsiderate to the candidates, unacceptable and completely avoidable. How hard would it have been for the College to allow candidates access to a trial version of the MCQ software in order to become familiar with the software? The answer, of course, is that it would have been very easy if only some thought and consideration had been applied. Such forethought and consideration was starkly absent from the College’s preparation for this exam.

The pinnacle of the College’s Piss Poor Performance was the SCQ booklet, which gave the appearance of having been knocked-up on a $50 printer from Aldi and photocopied too many times. The images looked as if they were low quality JPEG’s downloaded from the internet, particularly the ECG’s were of such poor quality that the lines on the ECG paper were indistinguishable and two wrist x-rays were reproduced at size smaller than your average smart phone screen, but so pixelated that the image had more in common with Minecraft than the professional exam it was supposed to be. Minor problems, you may argue, but with the pressure of answering a question in 6 minutes, is it reasonable to expect the candidate to squint at an ECG trying to calculate those essential characteristics or peer at a tiny x-ray image?

The booklet itself was bound with staples in such a way that, particularly towards the middle of the booklet, it was actually impossible to make full use of the provided space for the answer, hardly the hallmarks of a professionally executed exam. Was this deliberate cost cutting or was it just another aspect of the College’s woeful planning?

The time critical nature of the final exam had been hammered into us trainees for years in the old exam format and this emphasis has continued, yet the actual exam was almost impossible to pace. Where we have been told by our trainers that it should be a strict 6 minutes per question, this was impossible to maintain since some of the questions where 4 or 5 pages long, compared to others which were much shorter. The questions were not equal at all and were certainly not requiring the same time to answer. Why was this vital information not conveyed to the trainers and trainees? Why was a bank of sample questions of the new format not made available, along with marking scheme, to the candidates? The provision of handful of questions with scant comments does not provide an acceptable body of questions from which to practice.

The College must, somehow, be held accountable for this debacle. But it won’t be; it will be the candidates who will shoulder the consequence for the Colleges poor planning and preparation; it will be the candidates who will have to shell out another few thousand for another exam attempt; it will be the candidates who miss the opportunity of a specialist appointment; it will be the candidates and their families who are compromised. I am sure the College will absolve itself of all accountability by smugly declaring that the candidates did not prepare themselves properly, but how can we be expected to prepare ourselves properly when the College itself was not sure what was happening even in the final few weeks before the exam. The College was not prepared for this exam and should have been honest and transparent with its trainees from the outset.

Dr Chris Cheeseman NSW trainee