The Health Professions Council of South Africa (HPCSA) and the University of KwaZulu-Natal (UKZN) have come out with guns blazing following concerns raised by foreign-trained medical doctors. 

Last week, Health-e News wrote a story detailing the frustrations of foreign-trained doctors who accused the council of deliberately failing them during their board exams. The group of about 750 junior doctors who trained at universities in Russia, China, Mauritius and Italy complained about a high failure rate after only 30% of them passed these board exams. 

The doctors say they haven’t been given a chance to properly review the scripts of the exam which was administered by UKZN. Some of the doctors say the university gave them an hour to view their scripts. They discovered discrepancies, but did not explain to this publication what the discrepancies were.  The junior doctors represented by the South African International Trained Health Professionals Association wrote to the Information Regulator to compel the council Health Profession to release their scripts.

When Health-e News spoke to UKZN, the institution referred questions to the HPCSA. The response from the council was that the medical board examination is an important form of evaluating whether foreign qualified applicants possess the knowledge, skill and minimum competence to practise their profession.

The two institutions have now provided an extended response to the allegations.

Assessment of foreign trained doctors

In a six page joint statement the organisations say:

The medical examinations administered by the institution [UKZN] on behalf of the council are organised and managed with stringent adherence to both South African and international standards. 

HPCSA spokesperson Priscilla Sekhonyana says foreign qualified applicants’ qualifications are approved by the Education Commission for Foreigners Medical Graduates (ECFMG), an organisation that assesses qualifications of healthcare professionals. 

“The ECFMG assists with the verification of the legitimacy of an institution where an applicant may have trained. It however, does not confirm equivalence of curricula content that is recognised by the Medical and Dental Profession Board for South African institutions,” she says. 

She says the council and UKZN have a cardinal responsibility to ensure that only applicants deemed competent are allowed to practise without causing harm to South African citizens. 

“This is why credible examinations are organised to confirm if indeed applicants meet the highest standards of competence,” she says. 

70% failure rate explained

Sekhonyana says the medical board exam is a rigorous form of evaluation of whether the foreign qualified health professionals entering the system have adequate professional knowledge, skills, values and competence to practise their health professions. 

“It should be remembered that the exam is in the form of multiple-choice questions where manipulation is virtually non-existent. The candidate who knows the answer to the question will make a proper choice accordingly.” 

She says failure to pass the board exams may imply that the quality of training the doctors got does not meet the required standards. 

“The candidates sitting for these exams are never the same, especially when considering that they receive training in different parts of the world under different circumstances. For example, Ukrainian universities were severely impacted by the ongoing war in that country. It is therefore irrational to expect a similar pass rate each time an exam is taken,” Sekhonyana says. 

Sekhonyana says as much as most applicants under perform in the theory exams, the performance on the practical exam is more than satisfactory most of the time. A pass rate of 94% and 61% were achieved for the practical exams held respectively on 5 and 6 December last year and also on 7 and 8 May this year. 

Scope of exams

The junior doctors told Health-e News last week that the scope of the paper was changed seven days before they sat for the exams. However, UKZN refutes the allegations saying the scope, as outlined in the guidelines, is the sole responsibility of the council’s Medical and Dental Profession Board.  

UKZN media liaison officer Sejal Desai says the institution only advocated for the inclusion of the latest editions of textbooks, purely for the benefit of the candidates. 

According to the statement the guidelines indicate that online written examinations is a multiple choice examination which singles best answers. 

“There is no negative marking, it has two components, the first one consists of 75 items assessing clinical knowledge. The second component consists of 25 items testing ethical and legal knowledge.” 

Requests for exam scripts

HPCSA says the intellectual property of the information requested is owned by UKZN. 

“The institution is appointed by the HPCSA and providing access in a printed and electronic format would undermine the effectiveness of the examination system,” says Sekhonyana. 

She says even though the institution is in a position to refuse access to the examination records, it does offer supervised access to view the records at the appointed institution.  – Health-e News