Registration exam fiasco
04 Jul . 24 min read.
The June registration assessment for just under 2700 trainee pharmacists took place on Weds 29th June 2022 at 113 test centres across the UK starting at around 9.30am. However, it soon emerged that there were severe delays with the computers not arriving at the Nottingham site especially until much much later than anticipated which have already heightened their stress and anxiety during an exam situation. BTL took over from PearsonVue who were the invigilation service from last year that had various issues affecting a significant number of candidates during the pandemic and the first time the GPhC used an electronic format for their registration assessments.
There are two parts of the exam; Part 1 - Calculations (40 questions; 3 minutes per questions) over 2 hours and calculators were allowed from GPhC approved brands (this was recently changed from the Casio brand which most candidates were practicing with during most of their foundation training year) and Part 2 - Clinical (120 questions; 1.25 minutes per question) over 2.5 hours with no calculators allowed. The pass mark is at least 70% each paper.
100s of trainee pharmacists have messaged directly to myself and others as well as on various social media platforms and this is their feedback on the events since then which they would like to be anonymised for fear of reprisals.
GPhC has announced on the 29th June 2022 that ‘’the majority of candidates were able to complete the assessment with no issues. Five test centres in England experienced delays in starting either Paper 1 or Paper 2 due to IT or other technical issues.
The most significant issue affected candidates at a test centre in Nottingham where the delay was severe and candidates were only able to start Paper 1 in the late afternoon.
Duncan Rudkin, Chief Executive of the GPhC also added ‘’ “We are advising the candidates in Nottingham that we will accept the severe delay as grounds for appeal if they do not pass. This means that if they do not pass the assessment, this sitting would not count as one of their attempts to pass. We are considering what else we can do to support the affected candidates.’’
https://www.pharmacyregulation.org/news/registration-assessment-delayed-start-some-test-centres
However, the Nottingham candidates did not even get to sit Paper 1 until around 5.15pm! During the period from 9am til 5pm, these candidates were apparently made to sit in a room under exam conditions with three invigilators looking on and no offer of food provided. Already stressed due to the exam situation, the uncertainly has certainly affected the candidates on a human level, deteriorating mental health and not in a position to undertake such an important and life-changing examination at this point.
The candidates eventually started Paper 1 after 5pm and then only had a 15-minute break to consume food rather than the usual 1-hour break in between papers and started Paper 2 after 8pm. The candidates had to finish by 11pm to vacate the building. This did not leave any extra time allowed at all for those candidates requiring reasonable adjustment time which was agreed prior to the assessment and putting them at significant disadvantage to pass the assessment and causing much distress.
Feedback from the candidates that sat at the Nottingham site are shown below:-
‘’ People like myself were ready to sit at 9am and instead got faced with a decision to either leave and have to wait months to sit after months of work for this one day or to sit after being left in a dark unventilated room without food or drink for 7 and a half hours with NO ACCESS TO PHONES OR REVISION MATERIAL and restricted toilet access etc. repeatedly getting our hopes up being told it would be ‘soon’ only to wait another hour after hour.’’
‘’ The majority of the paper was also sat in the dark as it was going into the night so it was impossible to stay awake and focus on questions’’
‘’ The sad thing is because we actually went through so much and since the exam I can’t even go to sleep it has had a massive impact on my mental health’’
‘’ Everyone that is saying Notts cheated we had our phones always switched off in our bags and had invigilators with us at all times’’
‘’ I really really hope cheating didn’t occur as we did have at least one invigilator at all times, I can safely say myself that I did not have access to my phone the entire period and everyone around me was the same. If anyone was on their phone then it was extremely selfish and I would hope they would be dealt with separately to the rest of us who sat in exam conditions for nearly 8 hours and sat the exam fairly’’
‘’ Honestly pro reg is not ideal for everyone as most of us want to locum and the experience we have been through at Nottingham we don’t have the mental and physical ability to do the exam again, ideally we want the GPhC to pass us! We have prepared so hard for this exam and it was a complete shambles! Other pre reg at Nottingham with extra time didn’t even get to finish the paper and were told they had to leave the building!’’
‘’ The extra time students (those with agreed reasonable adjustments) sat the exam in the same room as normal students. There are people with anxiety that get extra time can you imagine how stressful it is having the whole room get up 45 mins before you finish and leave...not to mention the announcements invigilators make. This is the first time everyone is put together in the same room. PearsonVue and paper-based previous exams put people who have different timing in separate room. How is the GPhC not catering for the conditions of people. It’s not fair. Even if you don’t suffer from a condition just having people talking mid exam or moving causes stress and rattles them, imagine people who actually suffer from conditions. It’s so ridiculous.’’
This particular comment below gives a balance as well.
‘’Personally, I agree that there have been many errors across the country. I understand the frustration of peers however I would have given anything to have even sat at 10am in the poor conditions, it just seems like what happened to my cohort is being used as an excuse to start a whole thing taking away from the severity of what happened to us and treat everyone equally when realistically there are a majority who sat in normal conditions at the expected time and are using this as a get out free card just because the exam was hard, which I would find frustrating even if I was to have sat normally myself. I think they need to really investigate who actually reported issues at the time and who are just using this situation due to the exam being hard.’’
However, it soon emerged after the 29th June that other centres around the UK (more than the five originally stated by the initial GPhC statement) had various significant events and issues affecting the candidates ability to complete the registration assessments and not just the delays. This prompted the GPhC to put on a second statement on the 1st July 2022 stating that ‘’… Although the majority of candidates were able to complete the assessment with no issues, some candidates experienced delays in starting either Paper 1 or Paper 2 due to IT or other technical issues at a small number of test centres in England.’’
‘’ The GPhC Council today held an emergency meeting to urgently review the situation and what further measures could be put in place to support the affected candidates.
The Council noted that the GPhC has already confirmed that candidates who experienced severe delays will have their assessment fees refunded in full, and that the severe delay will be automatically accepted as grounds for appeal if they do not pass. This means that if they do not pass the assessment, this sitting would not count as one of their attempts to pass. ‘’
GPhC then further added a statement about provisional registration and that ‘’The Council agreed that the GPhC would offer provisional registration to candidates who were severely impacted by delays and so were not able to pass this sitting, providing they meet certain eligibility criteria. The GPhC will define the criteria of which candidates will be eligible for provisional registration and publish the criteria as soon as possible, so candidates know what their options are if relevant.’’
The GPhC did signpost candidates to Pharmacist Support and to take advantage of their wellbeing and Listening Friend schemes.
This created uncertainty about which sites other than Nottingham would an offer of provisional registration would apply to should candidates fail this particular registration assessment as delays was not the only issue.
Here are some of the responses from the candidates at other sites other than Nottingham that had a significant impact on completing their exam.
‘’ At my exam centre in Coventry the invigilators were very nice and I did not face any technical issues. However the noise of the use of mouses and keyboards and people leaving early chatting outside distracted me a lot especially in paper 1 which impacted my performance.’’
‘’ The GPhC are only addressing the severe delays in Nottingham because that’s what got more attention, but it’s supposed to be about fairness for every candidate - not a popularity contest’’
‘’ We need answers. GPhC are only addressing the people at Notts and the delays yet they have the option of going on the provisional register and we don’t? Utter disaster… we should all have the option. But aside from this. GPhC must be reviewed as this is not the first time it has happened and it won’t be the last.’’
‘’ The exam should not have to count if we fail for ALL PRE-REGS not just the people at Notts. And the future exams should represent the framework laid out.’’
‘’ In terms of delays and arrangements I was not affected at my centre. However, the GPhC have to look at this situation as a whole as there has been many mishaps across the board such as: severe delays and some having access to phones, the use of scientific calculators and calculators in part 2, the lack of professionalism from the invigilators along with server issues.’’
‘’ Also, we hear loads of reports of exam irregularities, where some ppl allowed to use scientific calculator for paper which is not allowed and some ppl use calculator for paper 2 the clinical paper which is also not allow, plus the recent report of the ppl who started late being given answers for exam questions by ppl who finished early’’
‘’ I sat in Brentwood. The least could be a pro reg but even then what would the criteria to fully reg. could we face another exam in a few months down the line to fully register and if so,that would course even more trauma on our mental health due to the uncertainty of a fair exam. As I mentioned leaving aside all the delays, people having access to the answers and using calculators (also scientific ones), the calculations were not realistic to the time we had available.’’
‘’ the Oriel process was perfect in the Pearson Vue centres as everybody had a suitable sized computer screen and area which was blocked with screens which felt so much more comfortable, and I didn’t have to feel paranoid about people looking. Exactly after all of this I think anyone from my test centre is highly unlikely to pass so we’re just going to have to go through all this stress again so as much as the provisional registration is helpful and a nice gesture it doesn’t make up for it’’
‘’ I sat my exam in Bristol. I’ve also heard from other candidates that calculators were not checked for in the part two exam. So some had an unfair advantage by bringing in calculators to an exam where calculators were not allowed. I just don’t see how the results from this exam can even be considered valid at this point’’
‘’ I just wanted to say that I was at Wembley test centre and although we were not as delayed as those in Nottingham we were also delayed and had people’s computers stop working during their exam - as well as a number of other inconveniences which affected us all. ‘’
‘’ It’s way more than 5, I don’t know any of my friends who their computer wasn’t giving them technical issues - but obviously at the time of the exam you don’t know that I thought it was only mine I was slowly breaking down that paper ruined me . I told them about the room being extremely small and other candidates being so close to me that I had no arm space they said there’s nothing they can do .. but they filled in an incident report form due to my panic attack . And my exam was in north west London in the Harrow centre. It’s NOT being recognised as 1 of the 5 centres but we still had plenty of technical problems , altho we were better than some. I didn’t manage to finish the second paper because of everything that happened , I did go through most quesitons but I wasn’t focused so idk how I performed’’
‘’ Exam conditions were beyond terrible. We were in a room of what looked like a basement, no ventilation or windows. About 15 people stuck in a room for 9 hours. We all complained it was hot and we couldn’t breathe they gave us a fan which was making noise that personally distracted me a lot. I also was only given two papers in the numeracy test and had to keep asking for papers. The screen also kept blacking out 10 mins before the end of each hour, all these factors played with my anxiety so much that I had to keep going to the toilet (went about 6 times in the second paper) and take deep breathes to avoid a panic attack. 2 hours into the clinical paper I had a panic attack and I all they did was take me to another room and sit there until I feel ready. I told them I can’t afford to do that because time is ticking but that room is so claustrophobic. I went back in a squeezed every ounce of my brain to finish that paper. 3 days later I’m still recovering from this horrible horrible experience’’
‘’ the test centres were not made to sit an exam in a quite environment. I had to share one table between another student who sat opposite me and every time she moved the table it was very distracting and I couldn’t even concentrate and felt paranoid someone sitting right in front of me . When I was about to start the exam my code didn’t work and they had to restart my computer which triggered my anxiety. Didn’t even start the paper with a calm mind set.’’
‘’The actual venue at Stratford Velodrome was terrible, very little working space on the desks everything was crammed together, only a quarter of my paper would fit on the desk whilst the rest hanged down, constant talking of the invigilators as they tried to resolve technical issues, people's screens randomly turning off. The actual function to scroll up to look at previous questions took ages. I also know of a student who's a type 1 diabetic and had a mild hypo episode because of being quarantined for hours! This is just cruel and unacceptable. It's affected everyone mentally emotionally and physically! They expect so much from trainees yet they seem to mess up every time.’’
‘’Also the seating plan was not acceptable. I was able to see computer screens of other students facing the same direction as me. There are screens such as in a bank which are either under the desk or the glass does not allow people around to see the light from the screen.
The exam software itself with multiple issues of it stopping during the exam to many people and disrupting them and the people around them while they try to sort a problem which the invigilators appeared to not have any real knowledge of how to solve as they would try to turn the device off and on leading to no success which would finally lead to them moving desks. Although this didn’t happen to me I pray this doesn’t occur if I need to resit the exam.
I found the software was not ideal to navigate between questions. I couldn’t look over all my answers at the end as I intended as I and many other students wasted so much time clicking multiple times to reach question 1 again.’’
‘’ My experience was horrible as the screen was too bright, it was dazzling my eyes and the invigilators didn’t know how to use the contrasts. I had to be moved with the same computer some place with less lighting to help- it didn’t. I was having a hard time making out the sentences from the brightness of the computer but they didn’t change it because apparently you had to sit both exams on one computer’’
Candidates also had the option to be given ear plugs. Is this usual practice at an examination centre? Surely if they knew the location was going to be noisy, then is that a suitable site to sit an exam?
‘’ I asked for these for part 2 because of excessive clicking from my neighbouring student (was necessary to check your answers). I hadn’t used them before, I squeezed them tightly and inserted them in both ears. They started to expand and eventually started to hurt. I took them out and started hearing the clicks again. I had to deal with pain and noise’’
‘’ We were all given these at my centre too and they were huge - I have small ears anyway but there’s no way I could use them - so uncomfortable and tbh, why should we even need these in an exam??’’
‘’We were given ear plugs which didn’t block any noise thus the clicking especially towards the end of the exam caused great disruption’’
‘’ Great Connaught Rooms, London ... there was some construction work was going on next building it was too noisy.... my screen got frozen twice and at the time of submission it gone completely blank. I asked the invigilator, but they were so chilled. After a while just exit msg appeared. I don't know if my answers were even submitted.’’
The content of the registration assessment was also called into question as they apparently do not match the mock or practice papers they had studied for and did not match the GPhC exam framework.
‘’ what can be done when the pre-reg exam part 1 is not what candidates were prepped for. One dilution question on the whole paper, no suppositories, no concentrations - none of the questions we were ready for, instead they decided to do page long complex scenarios and mostly questions candidates hadn’t seen before. Further to this, the new “approved” calculator they decided on this year I spent days prior to the exam looking in shops and could not find either brand. Only to find out on exam day it was ONLY available online from places like Amazon which left me to use the onscreen calculator. There were no calculator checks, so people were using any calculator anyway. And my onscreen calculator was getting stuck on buttons, I had manually used my mouse to click the numbers and I had to keep opening and closing the calculator. At one point it froze completely & I couldn’t enter anything, and I told the invigilator who said he can’t do anything which left me sat in a panic.’’
‘’ First let me start with the difficulty of the exam which never reflected the gphc framework. Nothing like what we have practiced over the last 5 years for calcs paper. The questions were so wordy and took people 4 min just to read and understand what was asked. I believe if pharmacist had to sit that maths exam they will fail it that how hard it was. ‘’
‘’ I felt like for paper one the maths questions were very difficult, and the questions were long-winded and very convoluted. Quite a few of them were like a page long with 2 tables. Some questions were long and were SPC resources too, which made it harder as it took almost 2 mins just to fully read the questions, never mind understanding. We weren't prepared for this as the GPhC sample questions on their website didn't reflect what came up in the exam. although we had a good training programme from our training provider, but honestly those questions I have never seen before
I repeat the maths paper did not reflect the GPhC sample paper questions on their website, nor the learning outcomes.’’
‘’ This was my second attempt and I’ve gone through several pharmaceutical calculation books and mock math questions, and never have I seen such wordy questions, long winded and under time conditions. They say 3 minutes per questions, and we are advised by our training companies to read question twice, there is no time but to run out of time. The sample questions they had this year where so basic and to the point, why have those questions if you are going to bombard us with essay questions. Clinical paper, the calculation questions were to complex to solve with no calculator in under 1.25min. I cannot remember from the top of my head what the questions was, as this has affected my mental state. Since Wednesday I haven’t been able to recover mentally fully. These issues aren’t being addressed.’’
‘’ This exam was a lot more challenging in every way. The test centre was tiny and cramped. We sat in desks right next to each other. The fan constantly blew away my notes distracting me in an exam pressed for time. I could see others’ screen and they could see mine. Both papers were unbelievably wordy in an exam with only a few minutes per question. The papers were made a lot more difficult than last year and this just brings into question the fairness of it all. How can this be standardised when other trainees were not subject to these awful exam conditions? We would really like to call out the GPhC on how they regulate their exam and cause trainees so much stress and financial difficulty with their fees and the requirement to take time off work.’’
‘’ Just to make it clear as well- the main issue with the whole cohort is that the exam was nothing like the sample papers, there style of questions that we had never seen on any mock papers or their own sample papers and the questions were too wordy and confusing.’’
‘’ also in paper 2 (non-calculator) the questions were difficult for example calculating Creatine Clearance questions and working out % values with difficult numbers without a calculator in non-calculator paper what was the reason for that? It’s literally like they kept questions they could guarantee people won’t get right’’
‘’ I did find the paper did not reflect the GPhC exam framework. Since this was my 3rd attempt I am extremely worried as this paper was not similar to any of the mocks, or even the sample questions the GPhC provided us. A lot of students have expressed the same views about this difficult paper’’
‘’ Bookings opened the day before the specified date. Then once we got to the date and time where we could book the system crashed for numerous hours. It took me 3 hours to book a slot and I was lucky as many students had to wait the following day to book their slots
Also at the very last minute,3 days before the exam updates were being made about the structure of the exam and no emails were sent to notify us of these changes!’’
‘’ If possible could you also raise these issues:
- there are a significant number of trainees that feel that exam was not representative of the framework itself or the sample questions. Calcs q were lengthy, clinical qs were random and like I said didn’t reflect the criteria specified in the framework.
- the exam software itself was very flawed as if it hadn’t been tested. Questions took ages to load the. Going between screens was difficult.
- the exam settings were also below standard. The exam was kept in places like hotels with building works going on outside and loud parties in other rooms making it so difficult to concentrate. Students were packed together so closely you could see each other screens with their answers
- invigilator were clueless! And very clearly not trained
- not only was the exam a failure but the booking system caused so much disruption’’
‘’ It’s also important to note that the exam was not reflective of the sample questions that the GPhC has put up on their website. The questions were lengthy and had tricky wording and with the time given it was race against time rather than internalising the information and answering accordingly. Similarly, the mocks provided by many of the training providers were very different to the exam. Why is it that the GPhC does not provide uniform content (pass papers and questions per chapter) that we can revise from. This has severely impacted the mental health of many trainee pharmacists if not all. Also, it’s well known that graduates and pharmacists from Europe do not have to sit any exams when they apply to work in the UK. Why’s there one rule for us and one rule for them? Why can’t our competency be tested throughout the training year? If there’s a shortage of pharmacists, surely the GPhC would want to see more on the register?’’
There was high chat amongst the candidates whether Pharmacy is a good career option for them
‘’ Literally. Its putting a lot of people off Pharmacy as a whole and those already involved are losing their passion for it. So many people are switching careers from Pharmacy as it is not worth it.’’
‘’ It’s been a complete disaster! When speaking about these issues with newly qualified pharmacists they aren’t surprised. This happens to a certain level every year!
Serious changes need to be made before November and the GPhC needs to fill is with confidence cause not a single trainee pharmacist has faith in them’’
The responses the GPhC had given were not satisfactory to the candidates
‘’ The response from the GPhC has been shockingly underwhelming, so many comments under their tweets and their solution is a provisional register for only those severely affected by the delays? This means that when a new test is produced and a candidate fails, they are withdrawn, which brings me to the point, how do you disqualify someone who you deemed to be competent enough to be on the provisional register?
Overall, I believe tangible solutions are needed such as lowering the grade boundaries or making the system fairer for all rather than focusing a small number of the cohort.’’
Mental Health issues
Lots of candidates have suffered from various mental health issues after the assessments ranging from depression, anxiety, PTSD and more seriously self-harming and suicidal ideations. Although the GPhC have highlighted to contact Pharmacist Support for support with stress, sleep and mental health wellbeing at 0808 168 2233 during their second statement, they also tweeted this during the weekend when Pharmacist Support were shut and they are only open during Monday to Friday between 9am to 5pm.
For those candidates that require emergency mental health support including self-harming intentions during the weekend especially, please contact The Samaritans at 116 126 or your local A&E dept. Also make an appointment with your GP and self-refer for Talking Therapies.
https://www.nhs.uk/mental-health/feelings-symptoms-behaviours/behaviours/help-for-suicidal-thoughts/
Possible solutions
· To consider provisional registration pharmacists for ALL candidates that have failed the recent registration assessments on 29th June 2022, not just the Nottingham candidates and the four other sites mentioned in the GPhC statement.
· To refund the GPhC exam fees from all candidates and not charge from future attempts
· If candidates fail, to ensure this doesn’t count as an attempt for ALL candidates that sat the recent registration assessments on 29th June 2022, not just the Nottingham candidates and the four other sites mentioned in the GPhC statement.
· Paper-based exams
· Using universities as an examination centre and using their staff for invigilation who are experienced
· To allow sample papers that actually reflect the registration assessments as per the GPhC exam framework, including calculations
· To consider the effect of third resitters and international students
· Clear action plan to prevent a repeat occurrence
Next steps
· Any feedback and concerns about the registration assessments, including any evidence of collusion or cheating, then please email the GPhC at their dedicated email address at regexam@pharmacyregulation.org
· Trainee pharmacists can also contact Pharmacist Support about options and if they feel they may need to withdraw, annul or appeal at https://pharmacistsupport.org/news/issues-with-the-june-2022-assessment/
· Trainee pharmacists can join the PDA Students membership organisation for FREE and they are a defence association and trade union representing pharmacists, pharmacy students and trainee pharmacists only at https://www.the-pda.org/get-involved/students/ and may offer legal advice as well.
· Trainee pharmacists to also consider filling in at feedback form from the BPSA about the registration assessment disruption at https://static1.squarespace.com/static/5dc842006d7ebd6c3fb7802a/t/62bef31c067517197b69fda8/1656681244403/Registration+Assessment+Disruption+Statement.pdf
· For those trainee pharmacists that are on Telegram and wanting to freely discuss the registration assessments, The Pharmacist Cooperative offer a safe space to air their views anonymously as well as about anything related to Pharmacy on the Pharmacy Lounge group at www.pharmacistcoop.co.uk/telegram/