Colleges of Medicine of SA statement on recent Surgery examinations

Organisation: Position: Deadline Date: Location:

The Colleges of Medicine of South Africa (CMSA) is the custodian of the quality of medical care in South Africa and is unique in the world in that it embraces 28 constituent Colleges representing all the disciplines of medicine and dentistry. Because the CMSA has the unique structure of containing all medical and dental specialities within a single framework, it has the potential to foster aspects of medical education and medical professionalism which are common to all disciplines.

This structure is unique to South Africa. Internationally, the various colleges nationally dictate the training criteria, manage the formative assessment as well as the summative assessment and award the Fellowship.

As the CMSA we strive to promote the highest professional and ethical standards through our primary role as an educational and postgraduate examining body.

We have always been committed to improving the health of all the people of South Africa, and energetically pursue the goal of making its multidisciplinary educational resources available to other countries in Africa. This is done through the endorsement of internationally recognised standards of human rights, condemning all forms of violence and a strong commitment to the development of a just and peaceful society in which
educational, health, recreational and other social services are available to all. The CMSA was appointed to run the exit examinations towards eligibility to register as a specialist in South Africa. The additional requirements for specialist registration are that Registrars must provide proof of completed training from the University as well as proof of having completed their MMed (research). Successful Registrars thus are awarded the Fellowship as well as the MMed.

Stakeholders
In South Africa there are a number of stakeholders involved in the process of post graduate medical and dental training and examining. The Registrars, the Department of Health, the Universities, the HPCSA and the CMSA. The roles of each of these stakeholders are very clearly defined but inextricably intertwined.

The registrars
The registrars are employed by the Department of Health but are appointed to a numbered training post by the training institution (University). The criteria for being appointed as a registrar can be slightly different in each University. All registrars at the end of their training write the exit examinations administered by the CMSA.

The training platform (University)
The training platform is currently solely responsible for the formative assessing and training of specialist trainees. It is the responsibility of each Head of Department (or his/her designated trainer) to sign off portfolios and certify that registrars have completed the minimum training requirements as per the CMSA regulations which are published on our
website, www.cmsa.co.za.

The Health Professions Council of South Africa (HPCSA)
The Health Professions Council of South Africa (HPCSA) is a statutory body and was established to provide for control over the education, training and registration for practicing of health professions registered under the Health Professions Act. In order to protect the public and guide the professions, council ensures that practitioners uphold and maintain professional and ethical standards within the health professions and ensure the investigation of complaints concerning practitioners and to ensure that disciplinary action is taken against persons who fail to act accordingly. Each department in each training institution is accredited for training by the HPCSA. These accreditations are done every 5 years. They issue training post numbers to the training institutions, linked to the funding of posts being available by the Department of Health.

The CMSA Constituent Colleges
The CMSA Constituent Colleges each have their own council, Secretary and President and have representation from all Universities. Two members of each college council also serves on the Senate of the CMSA and the regional standing committee. The Examinations and Credentials Committee, the Education Committee and the Finance and General Purposes Committee. Regional and institutional representation on these committees is strived for in all colleges.

The regulations for each discipline are mandated by these councils with input from the various training institutions. Trainers from the various training institutions are also appointed as the examiners. Even examiners from private practice must have some affiliation to an Academic institution.

Examinations
As per our examination policy, the examiners are not aware at the written of the identity or training affiliation of the various candidates. The CMSA passes candidates on merit only. The CMSA is committed to producing high quality specialists who will serve the entire health system which includes both the private and the public health sector.

FCS(SA) Final written examinations
The College of Surgeons (CS) FCS(SA) Final written examinations were conducted on the 25 and 26 July 2019. The results of this examination yielded a 44% qualification rate for invitation to part two of the exam, which has raised great concern for the CMSA and is receiving our utmost attention.

After publishing the final result, the CS convened an urgent meeting and the examination papers of the FCS(SA) Final were re-moderated by members of the Board of Examiners. The College of Surgeons examinations are conducted by a Board of Examiners appointed for the triennium (2017 – 2020).

The Board of examiners includes representation from all the training platforms across the country. An independent moderation and remarking of the FCS(SA) final was conducted by a panel of international experts from the Western African College of Surgeons, East, The College of Surgeons of East, Central and Southern Africa (COSECSA) and American College of Surgeons. The results of the international experts corroborate the CMSA results. There was no change in the results.

A further, comprehensive independent investigation into the broader FCS(SA) Final examination results has been commissioned and will include representation from all the training platforms plus a representative from the surgical registrar group. The Deans will be sent a copy of the full report at the conclusion of the investigation that will include findings and recommendations. We would like to emphasise that all candidates are entitled to, and encouraged to use the CMSA Appeals process. A copy of which is attached for ease of reference

College of Surgeons Examination FCS(SA)
The College of Surgeons examination is set by an examination board that includes representation from all the medical schools in the country. The question paper for each exam is approved by this panel of examiners. The examination paper is also moderated.

The examination is administered to candidates across the country. The FCS(SA) Final has two parts. Part 1 (written component) which was written on the 25 and 26 July 2019, consisted of 2 written papers. Part two (clinical component) to be written next week. Only candidates who achieved a sub-minimum of 45% in one paper with > 50% in the other paper are invited to the Part 2 of the examination. A candidate has to obtain an overall pass of 50% (combination of part 1 and part 2) in order for them to be awarded a fellowship in General Surgery.

Marking
All examiners mark independently of the training platform as they are appointed by the CMSA and have all signed CMSA confidentiality agreements.

Results
The results of the FCS(SA) Final part two second semester exams are as follows: 54 wrote the FCS(SA) Final. 24 of the 54 were invited to the clinical. The final results will only be calculated after the ratification of the full examination on 31 October 2019.

Comparison with the previous years
There has been a progressive decline in the pass rate.

Recourse for students who have failed
Candidates who have failed the written component during this semester will be able to enter for the FS 2020 set of examinations. As per the FCS(SA) published regulations, candidates may enter for the Final examination if they meet all the requirements. One of these requirements is that their FCS(SA) Intermediate must still be valid. In the College of Surgeons, the FCS(SA) Intermediate is valid for six (6) years.

Examination scripts are made available to all candidates who have failed including written feedback at the conclusion of the examination.
The examination Appeals process of the CMSA is as follows. (Policy document attached: CMSA – Policy Document – Candidates 2019-08)

The Timeline is as follows:

  1. Written examinations
  2. Provisional results (no marks) for invitations to the clinical examinations
  3. Clinical examinations
  4. Ratification of results by a full Senate meeting
  5. Breakdowns sent out to candidates
  6. Feedback is supplied to candidates who have failed the examination
  7. 21-day appeals window
  8. Candidates may apply for a review of their scripts against a bare-bones
    memorandum
  9. Candidates may immediately apply for a re-mark without following the review process
  10. Request for electronic copies of scripts (No MCQ scripts) as per PAJA
    Unfairness or discrimination

The majority of the candidates who passed the exam were candidates of colour from historically disadvantaged universities. The CMSA is committed to the highest standard of examinations and will not tolerate any form of discrimination. (Please see attached non-discrimination policy.) During a written examination only candidate numbers are used and there is no telling of who the candidate is. The candidates is unknown to the examiners. This ensures that the marking process is fair and unbiased. We are committed to our core values and have policies in place. As an additional measure, The CMSA has a whistle blower portal where candidates can report any issues including discrimination, etc. We also have regular meetings with registrar stakeholders and other stakeholders to continue dialogue and ease out any issues of
concern.

The CMSA remains committed to the values of justice and as such candidates taking the CMSA on legally is a constitutional right of candidate that is supported by the CMSA. We remain committed to just and fair exams where there is no discrimination, be it gender, race, etc.

We remain resolute in our mandate for a high-quality examination that will ensure that we have quality medical specialists who will deliver the best quality care to our people. Court Access to the court process is a constitutional right. The standards of passing medical and dental specialists are determined by the institutions and not the court process. As such these are two distinct processes. The CMSA will never compromise its examination standards, as doing so would be endangering the public. The court cases account for 0,01 % of our failing candidates.

Fees
The CMSA is a Not for Profit organisation and we do not profit from fees. The Fellowship fee is R12,100 and the remark fee is a maximum of R4,600. These fees are solely to cover the costs of conducting the examinations.


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