FPM Exam Handbook

The term “guidance” with respect to Royal College examinations refers to a meeting set up for the purpose of assisting candidates who fail at examinations.  The College has a long history of providing such interviews with the singular aim of assisting the trainee in identifying weaknesses in their examination strategy to improve their chances of passing on their next attempt. As a new Faculty examination, there is a need to offer this for Faculty of Pain Medicine (FPM) examination candidates who fail. The guidance that follows is to explain the process for triggering of an  interview, arrangement of the interview, conduct of the interview and subsequent reporting/documentation of the interview.

1.  Triggering the interview

The FPMRCA examination is a 'high stakes' examination insofar as the candidates sitting it have made Pain Medicine their subspecialist interest, and possession of FFPMRCA is highly desirable when applying for pain consultant posts.  It is also 'high stakes' because the examination is likely to occur within a year of the candidates applying for consultant posts, and time is at a premium.  With this in mind, it is reasonable that the Faculty’s approach in offering guidance interviews should differ somewhat from the College process, which only offers guidance interviews to those candidates who request it.  

All candidates who request the interview, even after failing the SOE part of the examination only once, should be offered an interview. Furthermore, all candidates who fail the SOE part of the examination twice should be offered the guidance interview as a matter of course, and must be invited to “opt in”. The Examinations Department will automatically send these candidates an “opt in” letter with contact details. The rationale for offering the guidance interview automatically for those who fail at the second attempt is that, while even good candidates can have a bad day on the day, or can underestimate the preparatory work involved and the standard required, failing the SOE section twice may have a more systematic underlying cause.

It is not anticipated that guidance interviews will be offered for individuals who fail the MCQ, as these are experienced examinees with respect to previous MCQ examinations. Failure is less likely to be a matter of technique and more likely to reflect inadequate preparation.

2.  Arranging the interview

The guidance interviews will be co-ordinated by the Examinations Department; these should be offered close to the locale of the candidate in question to facilitate accessibility.  As a minimum, in addition to the candidate, the interview should involve a Faculty of Pain Medicine examiner, and a College or local representative from the trainee’s region , preferably known to the candidate. Suitable representatives include Regional Advisor in Pain Medicine, Regional Advisor in Anaesthesia, College Tutor, Local Pain Medicine Educational Supervisor, or Educational Supervisor.  

It is fortunate that FPM examiners are geographically located around the country, and it is expected that most candidates would be geographically close to one or more examiners.  While it is expected that the College representative would be known to the candidate, it would be preferable if the examiner is not well known to the candidate and this will therefore require that candidate and College representative travel to meet the examiner or vice versa.  Reasonable travelling expenses will be met by the College.  The guidance interview itself will be led by the examiner.  A suitable venue should be chosen for a period of approximately one hour; it should be easily accessible and confidential. The Faculty of Pain Medicine could facilitate rooms for the purpose of guidance interviews in the London area if required

The attendance of a College representative will serve many useful roles.  Guidance interviews can be threatening for candidates, who may value the moral support of a senior educational colleague whom they know well.  In addition, the presence of an Educational Supervisor or similar would bring with them knowledge about the candidate’s training environment, and at the conclusion of the interview will enable them to facilitate focussed preparation for the candidate’s next attempt.  In addition, such an individual will act as a third party to help act as a safeguard for a process which can be emotive for the candidate and has the potential for misunderstanding.

3. Preparation for the interview

The candidates will already have been sent their scores in the examination and the pass mark for the SOE examination.  If they have not already requested their individual scores for the questions, these will be provided.  The examiner will be provided with the actual SOE mark sheets.  These will of course have the comments made by the examiners made at the time of the examination, which provide detail on candidate performance. Score sheets can be provided for all relevant examination attempts. It is a principal role of the examiner at a guidance interview to interpret these comments for the benefit of the candidate to give them a greater understanding of how they performed so remedial action can be taken.  The examiner will have, as part of the preparation for the guidance interview, reviewed the examination sheets, and identified possible deficiencies.  

In addition, the examiner will take a précis of the examination questions to the guidance interview.  It is imperative that the examiner does not take the actual examination questions with them to the guidance interview, as this could potentially breach stringent security arrangements, and potentially advantage the candidate in the guidance interview, as SOE questions do recur.  

The purpose of the précis is to remind the candidates of each question in sufficient detail to allow them to usefully reflect on their performance when the examiner’s comments from the exam sheet are explained to them.

4. Conduct of the interview

At the outset of the interview, it is essential to provide a brief introduction to highlight the aims of the interview.  It is very important to emphatically remind the other attendees, that the purpose of the interview is not to remark questions, nor to seek to undermine or invalidate the examination process, which is robust and quality assured, but to gain insights into individual performance issues that, once appreciated and remedial action taken, will increase the likelihood of success on the next attempt.  It is hoped that, given the maturity of candidates attending such an interview, they will already have considerable insight into their performance, and that the interview will help facilitate further insight.

In practical terms, therefore the aim of the interview is to:

• identify specific areas of inadequate knowledge
• identify specific areas of poor understanding
•  highlight performance issues eg failure to answer the question, the need for excessive prompting, lack of fluency
• understand the influence of background issues eg anxiety (possibly part of the candidate’s personality, or if situational, likely related to the candidate’s own insight into gaps in their knowledge or understanding), or personal or health issues.

The candidates should be invited to indicate what they think did well and what they think they did badly.  Such disclosure will give the examiner an idea of the candidate’s insight and this can usefully direct discussion accordingly.  

The candidate’s local representative could contribute background information on the candidate’s training environment and engagement. However, it is important that the guidance interview does not become a forum for discussing local training issues; these should be directed via the candidate’s RAPM, and dealt with accordingly.  

Like any feedback exercise, the aim is to emphasis the positives – ultimately, with appropriate preparation, this is an eminently passable exam, and the candidate’s chances will improved by engagement in the guidance process. 

It is useful to go through each question systematically, and ask the candidates to reflect on whether, on sober review, the marks awarded for each question were a reasonable reflection of their performance.
 
If more than one attempt has been made, and the SOE marks show improvement over time, this can be seen as encouraging. If however that is not the case for multiple attempts, or the marks are absolute fails (rather than borderline), then focus can be directed to exam performance issues (in this case exam practice may be beneficial), or discussion of training needs or study effectiveness.
 
The ideal outcome at the end of this process, is that the insightful and mature candidate will be in broad agreement with the marks given, and identification of remedial actions will have emerged.  

If however, at any point, the candidate voices significant disagreement with the scores given, and is not accepting of the guidance given by the examiner present, the candidate should be informed of the Faculty appeal process. If the candidates indicates that they would like to pursue this, the interview should be terminated forthwith and the Examination Department informed of the outcome.

5. Interview Report
A proforma will be provided. It will include candidate’s details, and names and roles of others present.  It should be filled in by the examiner, indicating areas of discussion, common themes that emerge, and remedial actions suggested. This should be completed at the time of interview, and all parties should sign the document. Filling the document in subsequently, and forwarding it to other parties present later, runs the risk that there may not be agreement on facts or opinion which would undermine the process.

The report should be returned to the Examinations Department, where a copy will be sent to all those attending and to the Regional Advisor in Pain Medicine in the candidate’s locality if not actually present at the guidance interview.

In conclusion, it is anticipated that the overall annual number of candidates requiring guidance will be low, and it is likely that each examiner will only be involved in interviews on an occasional basis.  However, it is anticipated that this would be a rewarding task for all those involved; it is especially so when a candidate from a previous guidance interview sends you an email indicating they have passed!