Better Health For All

Two linked but separate pieces of work are being undertaken on the administration of the Part B Membership of the Faculty of Public Health (MFPH) examination. Firstly, a review of the application policy and procedure for the Part B MFPH examination led by Dermot Gorman. Secondly, an option appraisal of approaches to flex the annual capacity for the Part B MFPH examination. The examination itself is not changing.

The task and finish group looking at renewing the policy and procedures for Part B MFPH are considering the cancellation policy, early confirmation of place allocation, priority waiting list and fast track procedures. When I asked Dermot to lead the work I was clear that the critical thing was to get it right, that is acceptable to all stakeholders, rather than completed quickly. The group’s original proposal which was considered by the Education Committee in August was not acceptable to registrars, but I hope that the Education Committee will be able to unanimously approve an amended proposal in November to enable implementation this year.

The 2019 Part B MFPH examination sittings are heavily subscribed, and as a consequence FPH have scheduled an additional fifth sitting. This, however, is very much an exception based on apparent demand and may well run at a loss for FPH. The inclusion of an exceptional fifth sitting in 2019 does not set a precedent for future years.Most registrars who have passed the Part A MFPH examinations on or after January 2017 have now applied for the Part B. The Faculty have always routinely scheduled four Part B examinations per year giving capacity for 96 candidates, and on every occasion in the past when a fifth sitting has been added it has led to the cancellation of a subsequent sitting because of insufficient demand.

The issue with waiting time is the result of small number variation; the number of registrars recruited varies slightly each year as do pass rates for both examination. The only option to date for increasing capacity has been to add a sitting, but this adds 25% more capacity in a year which to date has been larger than the demand.

Personally for me the most significant consequence of unfilled examination places, even if as I hope the new policy and procedures for Part B do not require cancellation, are not the extra cost but the impact on our examiners. These unpaid volunteers are the unsung heroes of the Faculty, who do not get the thanks they deserve. Not only do they have to write, test and quality assure additional examination material but they have to travel and often stay away from home to deliver the examination. So thank you Faculty Examiners.

The fees for the Part B examination in 2018 are £875, but the cost of delivery of each place is £950 if all places are filled and it is not necessary to use more than one place to enable reasonable adjustments. The difference which in practice is actually greater is subsidised by membership fees.

I have set the Faculty staff a very tough challenge. Is there a way to increase the capacity of a Part B MFPH sitting without increasing cost? The ability to both flex capacity and minimise examination fees would be a prize well worth having.

This is not as easy as it as first seems. The current circulation of 12 candidates through a morning session of the Part B examination is timetabled as follows:

Cohorts of six candidates have a slightly staggered start and the timetable allows for eight minute preparation for candidates before each examination station. The afternoon session mirrors the morning with suitable adjusted times.

Potential Alternative

It is common to use rest stations in clinical OSCEs, and an alternative model which utilises rest stations for candidates is described below which would allow 14 candidates to sit in a morning (or afternoon) session.

This would provide 4 extra places per sitting and 16 additional places per year at minimal extra cost. Ignoring small marginal costs and using the same assumptions of filling all places and not using more than one place for any reasonable adjustments, the cost of delivery per place could be significantly lower.

I will let you the reader work out the potentially unacceptable aspects of the particular model described above. I would like to mobilise the considerable intellect of the Faculty membership. Please send to Educ@fph.org.uk a clearly specified timetable for a model that increases the number of candidates who can be examined in a session from the current 12 with the same number of examiners AND provides an ideally identical but at least equivalent experience for all candidates. To enable this model to be considered by the next Education Committee please submit any proposals before the end of October.

I have described the challenge as a prize well worth having, and I will personally endow a small prize for anyone who submits a model that meets these criteria that is implemented by the Faculty.

Written by Brendan Mason FFPH, Chair of the FPH Education Committee