Performance in candidates declaring versus those not declaring dyslexia in a licensing clinical examination

Abstract

Context High‐stakes medical examinations seek to be fair to all candidates, including an increasing proportion of trainee doctors with specific learning differences. We aimed to investigate the performance of doctors declaring dyslexia in the clinical skills assessment (CSA), an objective structured clinical examination for licensing UK general practitioners. Methods We employed a cross‐sectional design using performance and attribute data from candidates taking the CSA between 2010 and 2017. We compared candidates who declared dyslexia (‘early’ before their first attempt or ‘late’ after failing at least once) with those who did not, using multivariable negative binomial regression investigating the effect of declaring dyslexia on passing the CSA, accounting for relevant factors previously associated with performance, including number of attempts, initial score, sex, place of primary medical qualification and ethnicity. Results Of 20 879 CSA candidates, 598 (2.9%) declared that they had dyslexia. Candidates declaring dyslexia were more likely to be male (47.3% versus 37.8%; p < 0.001) and to have a non‐UK primary medical qualification (26.9% versus 22.4%; p < 0.01), but were no different in ethnicity compared with those who never declared dyslexia. Candidates who declared dyslexia late were significantly more likely to fail compared with those candidates who declared dyslexia early (40.6% versus 9.2%; p < 0.001) and were more likely to have a non‐UK medical qualification (79.3% versus 15.6%; p < 0.001) or come from a minority ethnic group (84.9% versus 39.2%; p < 0.001). The chance of passing was lower for candidates declaring dyslexia compared to those who never declared dyslexia and lower in those declaring late (incident rate ratio [IRR], 0.82; 95% confidence interval [CI], 0.70–0.96) compared with those declaring early (IRR, 0.95; 95% CI, 0.93–0.97). Conclusions A small proportion of candidates declaring dyslexia were less likely to pass the CSA, particularly if dyslexia was declared late. Further investigation of potential causes and solutions is needed.

It’s Time to Be Scientific About Dyslexia

“…Such reasoning, currently less prevalent in the United States than the United Kingdom and some other countries, is based on observations that those with severe reading difficulties are more likely than normal readers to present with various cognitive difficulties, thus leading to the conclusion that they are markers of dyslexia. Commonly sought cognitive indicators include difficulties with memory (particularly working memory), processing speed, attention, concentration, time management, self‐organization, and the capacity to express oneself orally (Asghar et al, 2018; Asghar, Williams, Denney, & Siriwardena, 2019).…”

“…Dyslexia 4 throws up a host of conceptual, operational, and ethical difficulties. Often applied to adults and diagnosed relatively late in their lives (Holmqvist, 2020; Locke, Alexander, Mann, Kibble, & Scallan, 2017), the diagnosis can be used to obtain various educational accommodations and resources (Asghar et al, 2018, 2019; J.G. Elliott, 2014).…”

Candidate perceptions of the UK Recorded Consultation Assessment: cross-sectional data linkage study

“…This study shows that, despite responders' hope that the exam would be less prone to differential attainment, there were differences in attainment for minority ethnic candidates and International Medical Graduates as found in the CSA [15]. Although male gender and disability were associated with a lower odds of passing, these differences were not significant, in contrast to differences found in the CSA but this may have been because of low numbers [15,16]. An important factor was the association with English as first language with an increased chance of passing, which has been identified as a possible cause of difference in performance in licencing exams [17].…”

Dyslexia in higher education

“…Only 30% of individuals from the bottom income quartile are expected to enroll in college, compared to 80% in the top quartile, and those in the highest quartile are six times more likely to obtain a degree by age 25 (Goldrick-Rab et al, 2016). College preparedness seems to play a large role as well; students who are well-prepared before entering college are more likely to receive a degree, which likely contributes to the income disparity in achievement (Asghar et al, 2019). Some scholars have argued that the rigid classroom structure in American education simply does not fit all people, particularly those with learning difficulties or from other countries (Waitoller and King Thorius, 2016).…”