The Pharmaceutical Journal
Vol 273 No 7325 p712
13 November 2004

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Does the registration examination serve any fair or useful purpose?

By Sultan Dajani

The Royal Pharmaceutical Society’s registration examination was born out of the recommendations of the Nuffield report in 1986. Its proponents see it as the crowning apotheosis of pharmacy education and a valuable test of competence to deal with the real world. Unfortunately, in its current format it cannot measure either; the examination merely tests knowledge and time-keeping skills and highlights variations among preregistration tutors, the laborious nature of the preregistration year and the quality of advice given to students. By maintaining the registration examination, the Society is in effect saying that the degree is inadequate. It should, therefore, focus on updating the degree syllabus, add further relevance to
the final undergraduate year and develop practical Objective Structured Clinical Examinations. In my view, it is time the examination was scrapped.

There is no evidence to prove that those pharmacists qualifying after 1992, who have taken the registration exam, are any more competent than those who did not. Even to suggest this is extremely capricious. I, of course, do not support this hypothesis because, even though I sat the examination, most members of Council have not, yet they are deemed competent enough to govern and lead the whole profession.
Interestingly other health and non-health professions have questioned the worth of a registration examination. The General Medical Council, for example, strongly supports the quality of its degree syllabus because after five years and one year of preregistration experience there is an automatic registration — subject to searching appraisals. The GMC has considered introducing an examination but decided to focus on revalidation and formalising the appraisal. Other professions, including veterinary surgeons, accountants, teachers, dentists, nurses and optometrists, do not have a routine registration examination; if they do, it is only to test overseas students if their degree was obtained from an unaccredited teaching establishment.

One problem with the Society’s registration, in my view, is rule that it can only be attempted three times. In contrast, the Royal College of Physicians is against limiting the number of attempts to retake failed assessments because this was “not seen as a good enough reason in itself”, and even driving tests can be attempted as often as is necessary to pass.

In 2001, the time limit on numeracy tests for teachers was dropped and Estelle Morris, the then Education and Skills Secretary, said at the time: “We have listened to the concerns expressed and feel that offering greater flexibility is the way forward.”

I would be interested to see if there is any evidence that shows those who have passed on the third attempt are more competent than those who might have passed on the fourth or fifth attempt. The Council will counter-argue that a fourth attempt is possible in exceptional circumstances.

Removing the limit on the number of attempts at the examination will not cost the Society nearly as much as it is costing now and there will be no grey areas.
A further consideration is the priority the Society attaches to it. Without validation of the examination, or the necessary evidence for its effectiveness, the Society could be accused of wasting hundreds of thousands of pounds.

Even better, if the examination were to be abolished and staff resources and expenditure rechannelled into revalidation, innovation and other constructive work, we might be able to minimise future increases in registration fees.

The registration examination is not part of the pharmacy degree, it is not taught at universities, and it is not funded the same way or by higher education funding councils. It is merely a bolt-on and, as such, its removal is merely a reversal of its introduction. Supporters of the examination propose to await the forthcoming Section 60 Order but since the examination was introduced well before the Health Act in 1999 this has little relevance. The question is not whether Section 60 will allow the examination but whether it makes it compulsory and, in the absence of obligation, we should ignore it.

Just because the examination is lawful, it does not necessarily make it right that it is compulsory. It would be equally lawful not to have the examination, as is the case with most other health professions.

Finally, that the examination is necessary to introduce common outcomes is a common misperception. Proponents say the preregistration year has a lot of inconsistencies which warrant an examination at the end to ensure consistency of knowledge and to act as quality assurance. Surely, therefore, it would be far more sensible to ensure a stronger focus in consistency through needs assessment than by having an examination.

In addition the consistency argument does not substantiate the need for only allowing a limited number of resits and there is no evidence that variability in an already rigorous appraisal system during the preregistration year was detrimental before the introduction of the examination. If the examination were about ensuring consistency of knowledge at the end of the year, then it would be important that those who have failed are given an in-depth analysis of what and why they failed or which questions they got wrong.

Until examination feedback is vastly improved or until this information is made more available this argument in favour of the examination cannot be supported.

One further point: it is extremely condescending that a candidate can pass a degree course but is then deemed incompetent to practise.

In light of these arguments, the registration examination seems ponderous and unwarranted. No doubt the Society will argue that it is close to the quality agenda and content to be leading the way. More to the point there is no raison d’être for leading if the way means most other health professions will not follow and we are introverted by our policy. With hindsight, I believe the Council would never have agreed to introduce the preregistration examination or have agreed to a limited number of resits.

It is no wonder that other health care related professions refuse to introduce registration examinations. Indeed, those who adhere to best practice, innovation, patient welfare and outcome delivery must oppose them.

The Society’s examination is irrational and no longer practical, and those who promote it are behind the times. Is the examination and its format morally flawed, professionally outdated and unjustified? Does it serve any useful purpose? Should it be annulled or should there be an examination without a limit on the number of resits?

For the good of the profession it is time to for a proper debate and consultation.