Dr Divya Tiwari is Chair of the SCE Geriatric Medicine Exam Board and a Consultant Physician at University Hospitals Dorset NHS Foundation Trust. She blogs here about her recent article in Age and Ageing journal.
I have been involved with the Specialty Certificate Examination (SCE) in Geriatric Medicine for over a decade, serving in various roles: as a member of the Standard Setting Group and Question Writing Group, as Secretary to the Exam Board, and, since 2022, as Chair of the Exam Board.
The Federation of the Royal College of Physicians (RCP) oversees a rigorous and meticulous process to ensure the quality and fairness of this examination. This process ranges from question writing, to creating and maintaining the question bank, reviewing content in line with the current blueprint, evidence and guidelines, setting the pass standard, and analysing statistical performance after each exam diet. These steps are carried out collaboratively by dedicated Federation staff and clinicians who sit on the various exam boards.
Even with such robust systems, we have learned that minor statistical anomalies can be complex to investigate and, at times, may have significant consequences for candidates and their careers.
Recently, we undertook a quality improvement project to better understand the declining pass rates observed in the SCE for Geriatric Medicine. This was done in a spirit of transparency and with the aim of ensuring that the SCE continues to serve the best interests of patients, candidates, and the wider profession — in line with GMC expectations.
It is important to note that this trend is not unique to Geriatric Medicine: six of the eleven SCEs have reported a similar decline in pass rates. Factors such as changes in exam frequency, adjustments to standard-setting processes, and the broader impact of the COVID-19 pandemic coincided with these shifts. Our study explored their influence on the validity, reliability, educational impact, and candidate demographics of the exam.
The analysis showed that reliability and validity parameters remained within acceptable ranges, even for exams with lower pass rates. However, diets with lower pass rates included a significantly higher proportion of International Medical Graduates (IMG) compared to UK Graduates (UKG). We also found that IMG were more likely to fall within the ‘borderline’ group — candidates with roughly equal chances of passing or failing — whereas UKG were more frequently represented in the upper quartile of passing scores. In short, the likelihood of passing the SCE is currently lower for IMG trainees compared with UKG.
As an IMG myself, I remember sitting the pilot for this exam before it became a mandatory component for CCT in 2009. I deeply appreciate the challenges faced by colleagues navigating this process, and I want to reassure readers that both the BGS Education and Training Committee and the Specialist Advisory Committee (SAC) are committed to identifying and developing additional educational and training support for IMG trainees to help narrow this gap.
I send my best wishes to all trainees.
Read the full article on the Age and Ageing journal website: A study to understand the factors impacting pass rates for the Specialty Certification Examination in Geriatric Medicine to improve outcomes and reduce variation
