Internationally qualified doctors say the final exams for psychiatry fellowship are unfit and unfair. The college disagrees.
The Royal Australian and New Zealand College of Psychiatrists has denied that international medical graduates on its training pathway are disadvantaged, but at least one registrar tells a different story.
Last week, Rheumatology Republic’s sister publication The Medical Republic published an opinion piece from specialist psychiatrist Dr Helen Schultz following the release of the latest round of RANZCP exam results.
The psychiatry examination is multi-faceted – successful trainees have to complete a psychotherapy written case, a clinical competency assessment and a scholarly project as well as exams.
The RANZCP no longer holds a clinical exam; after registrars have finished training, they must pass a multiple-choice exam, critical essay question exam and a modified essay questions (short answer) exam.
Each of the exams cost about $1500 and requires registrars to answer in English. Traditionally, around 65% to 75% of candidates pass the CEQ.
In the latest round of exams, 56% of candidates passed the CEQ and 61% passed the MEQ.
Dr Mpho Radebe was not one of these candidates.
The internationally trained doctor has sat the MEQ 11 separate times and failed on each attempt – despite working as a senior CMO in a mental health short stay unit.
He is now planning to return to Botswana with his family in 2025.
“I passed all my other exams first go, except this essay,” he said.
“All my reports for my formative assessments were top-notch.
“After each failure, it’s like the college is saying that I am not good enough … [even though] I’m doing the job.”
Despite his repeated exam failures, Dr Radebe said he has run his unit “impeccably and basically with minimal supervision”.
He has done specialised training with the college to help prepare and has been told he is ready to sit the exam, only to fail again.
Dr Radebe said he has heard from other internationally trained doctors working in psychiatry who have felt the system was working against them.
“I’ve [spoken] with a number of people of colour who are working in the system, and most of us have failed an exam at least five times or six times,” Dr Radebe said.
“Some of them are feeling suicidal in a process which we feel is racist.”
For its part, the RANZCP said internationally trained doctors were “vital to growing a skilled, compassionate and culturally informed mental health workforce”.
Fellows like Dr Schultz have questioned the usefulness of assessing candidates’ written communication at all.
“We have hundreds of trainees stuck in a holding pattern waiting for the next chance to sit their exams,” she wrote in TMR.
“For some that’s because English is not their first language and they are disadvantaged by having to write an English essay.”
While acknowledging that international graduates have lower pass rates than their Australian-trained peers, the RANZCP denies any claims of discrimination.
“This transition [to a new health system] is not easy, as it often involves navigating a different healthcare system, adapting to a new language and cultural environment, and qualifying rigorous professional assessments to be able to do your job,” the college told TMR.
“Despite these challenges, [specialist international medical graduates] bring invaluable perspectives and skills to psychiatry, enriching the care available to our diverse communities.
“To support them, the college has implemented tailored initiatives, including enhanced exam preparation resources, study networks, training and mentorship opportunities with [specialist international medical graduate] fellows who have navigated similar paths.”
The college will also directly contact doctors who have failed on multiple occasions to offer targeted support and runs dedicated exam preparation courses and study networks for overseas trained doctors, and allows extended exam times and additional training.
Exams are graded anonymously using randomly generated ID numbers, so there is no question that graders will know exactly whose assessment they are marking.
For the CEQ, which requires candidates to respond with an essay to a quote about psychiatry, at least two independent examiners will mark each essay.
Any disagreement is reviewed by a third examiner.
Examiners marking the MEQ follow detailed marking guides and undergo “calibration sessions”.
From early 2025, the college will hold slightly less power for internationally trained doctors.
Those who have fellowed as a specialist psychiatrist in a country deemed to have a similar training pathway to Australia will be able to register as a specialist directly with AHPRA, without having to go through the RANZCP.
