BOARD EXAMS.html
Board exams for South African radiology registrars: the playing fields are leveling
The introduction of a single exit exam for all medical specialties is welcome and addresses the perceived
incongruence between the examinations offered by the College of
Radiologists and the various universities in South Africa. Till now,
the dual system in place has caused significant debate and offered
examination candidates an alternative route for obtaining a degree
acceptable to the Health Professionals Council of South Africa (HPCSA)
allowing independent specialist practise.
Supporters of the university-based Master of Medicine (MMed)
examinations have in the past consistently maintained that the
standards of their examinations have been high, and possibly even of a
higher standard than the College examinations. More importantly,
however, the MMed examinations with the addition of a research
component qualified for a government subsidy and often resulted in the
only radiology research conducted in the country. Lastly, the MMed
examinations were often conducted in Afrikaans, which gave
Afrikaans-speakers an equal opportunity.
On the other hand, the
‘internal’ nature of the MMed examination lent itself to
severe criticism, with allegations of leniency towards poor candidates.
Even with inviting an external examiner, the locally based examination,
the weighted examination panel, internal convener and local examination
material would create a particular style of examination that would
sometimes not
be considered unbiased. Visiting examiners would also tend to be chosen
from other universities offering the MMed examinations because of the
convenience of reciprocating, and also because of the ability of those
examiners to examine in Afrikaans.
Complex scenarios would arise
where a candidate failing the College examination would then attempt
the local MMed examination. Whether the candidate was better prepared
for the second exam or happened to fare better ‘on the
day’, would be ignored in favour of the supposition that the MMed
examination was of a lower standard – a plainly unfair but unavoidable assumption.
In response, some universities offering an MMed exam would set a more
difficult exam or sometimes prevent a poor candidate from sitting the
College examination for fear of this scenario discrediting their local
examination. I personally am aware of 4 candidates who were prevented
from sitting the College exam because they were not as well prepared as
their local contemporaries, who were allowed to sit the College exam.
The College of Radiologists has been well positioned to take
on the role of an independent examining body hosting a national
single-exit examination, and has been awarded this responsibility. The
College councils and examiner boards, however, are made up of heads of
department and examiners who hail predominantly from the universities
around the country. The individual colleges must therefore be careful
not to replicate the MMed scenario, where examiners at a particular
examination centre location originate from that very site or its close
affiliates (e.g. Pretoria with MEDUNSA; Stellenbosch and UCT). The
College of Radiologists has recognised this (through previous
experience) and opted to modify its examination process to include
examiners from all universities and some from private practise at every
examination, regardless of the location of the examination centre (at
the significant cost of flying all of them to the examination centre).
Offering the examination in Afrikaans is more of a problem
than a solution. It begs the question ‘Why is the exam not in
other languages spoken by the majority of the South African
population?’ The examination is best conducted in English, an
international language widely spoken in South Africa and the language
in which most radiology textbooks currently in use in South Africa are
written.
The strategic step of making a research component a
prerequisite for registering as a specialist with the HPCSA lays to
rest the argument of qualifying for government subsidies. The
universities can now provide the infrastructure to produce MMed
research which, together with the single-exit examination, qualify for
an MMed degree, and therefore a subsidy. This is a greatly welcome
mechanism of forcing research back into the training environment and
into candidate registrars’ minds.
There are significant challenges for meeting the new
requirements. The College has to now demonstrate its ability to host a
national exam in an independent and unbiased manner. It must also
invest in modern examination techniques including digital platforms,
internationally recognised examination methods, and a well trained and
expanded examiner panel. Universities also have significant challenges
in providing training to ensure success of their candidates in an
examination that will be perceived as a measure of the quality of
training. Furthermore, those universities without a research history
will have to invest time, human resource and possibly money to provide
the infrastructure for research. The main challenge for them will be to
find adequate supervisors and mentors. Registrar candidates will have
to juggle their time to be able to learn ever-increasing radiological
information and gain the experience required to practise independently
while making time for their research component. The College
applications to extend radiology training to a 5-year programme have
gone unrewarded by the governing body. To compensate, the College has
provided a Part I examination that can be taken prior to entry into the
registrar programme. This allows prospective registrars an opportunity
to prepare themselves for the registrar programme, gives successful
registrar applicants added credentials for being selected into a
programme, and provides universities with candidates with proven track
records who are ready to start preparing for Part II over a full 4
years.
I am extremely confident that this is the correct way towards
producing top-notch radiologists who have been adequately examined in
an unbiased fashion. I am also excited at the future, which promises to
yield a plethora of radiological publications emanating from local
material. I look forward to having radiological leaders who work
together under the banner of the College of Radiology of South Africa
and alongside the Radiological Society of South Africa, to secure our
future.
Professor Savvas Andronikou
Department of Radiology, University of the Witwatersrand
President of the College of Radiologists of South Africa
Chairman of the South African Society of Paediatric Imaging