MRCGP exam reasonable adjustments

The Equality Act 2010 requires the RCGP to make reasonable adjustments where a candidate, who is disabled within the meaning of the Equality Act 2010, would be at a substantial disadvantage in comparison to someone who is not disabled. The RCGP is committed to take reasonable steps to overcome that disadvantage.

The Equality Act defines disability as a physical or mental impairment which has a substantial and long-term (usually more than 12 months) adverse effect on someone’s ability to carry out day-to-day activities.

Candidates with conditions that fall outside the Equality Act 2010 definition of disability, e.g., conditions that are short-term and/or do not have a substantial adverse effect on the candidate's day-to-day activities, may be eligible to apply for a reasonable adjustment.

Whether an adjustment will be considered reasonable will depend on several factors which will include, but are not limited to:

• the needs of the candidate who has requested the adjustment;
• the effectiveness of the adjustment;
• the cost of the adjustment; and
• the likely impact of the adjustment upon the candidate and other candidates.

An adjustment is not considered reasonable if it:

• involves unreasonable costs to the College;
• involves unreasonable timeframes; or
• affects the security and integrity of the examination.

Any requests for reasonable adjustments have to be agreed before booking an examination (deadlines for submission of requests are at the top of this page).

Each request for reasonable adjustments will be assessed by the examinations team, advised by the MRCGP Disability Advisor as necessary. In complex cases it is possible that the Chief Examiner and an advisory group may also be involved in the decision-making.

Once the request for reasonable adjustments has been processed, candidates will receive an email listing the reasonable adjustments that have been accepted for the relevant examination.

Appeals against decisions made in relation to reasonable adjustments should be addressed to the Chief Examiner and sent to exams.accoms@rcgp.org.uk.

Confidentiality

Information and evidence about a candidate's disability and requirement for reasonable adjustments will be treated as sensitive personal information in line with the Data Protection Act 2018.

It will be kept confidential within the examinations team and only passed to those who need to know. In some cases, this may include the decision makers (in the case of an appeal) and examiners.

Part of the consideration of your request may need to involve, with your consent, information from your workplace Educational Supervisor or training organisation. In such circumstances, if you do not consent to your Educational Supervisor being contacted, then the RCGP cannot guarantee that all reasonable adjustment requests will be granted.

If you are granted reasonable adjustments, then this will be shared with Pearson VUE (PV) for the purposes of delivering your AKT examination and Professional Role Players (PRP) for the purposes of delivering your SCA examination. You will be asked to indicate your consent for sharing this information on the online application form.

Your submitted evidence will be securely deleted 28 days after the exam results are published.

Please make sure to read the reasonable adjustments policy and procedure before applying for reasonable adjustments for your examination.

Each application for reasonable adjustments will be assessed on a case by case basis. Below is a list of the supporting evidence you need to submit together with your online form:

• Specific Learning Difficulty (SpLD) - Full Psychology/Neurodiversity assessment report
• ADHD and ASD - Assessment by a psychologist or Psychiatrist confirming the diagnosis or a letter from the GP. (a screening test which indicates the above is not sufficient)
• Physical conditions - GP and/or specialist letter.
• Pregnancy and breastfeeding - MatB1 form, letter from midwife, GP or hospital letter.

If you are seeking reasonable adjustments for a specific learning difficulty (SpLD), then you must provide a report from an approved assessor. This assessment needs to have been undertaken, and provided, in English and be obtained after the age of 16.

Approved assessors include:

• Specialist teachers who hold a practising certificate in assessing specific learning difficulties from their relevant professional body, such as Dyslexia Action or PATOSS. You can find out whether a proposed assessor has the appropriate qualification by checking the SASC (SpLD Assessment Standards Committee) website.
• A practising chartered or educational psychologist who is registered with the Healthcare Professionals Council. You can check whether a proposed assessor is registered by checking the HCPC register.

For certain complex reasonable adjustment applications, we may ask you to contact your Educational Supervisor for a supporting letter. This should highlight your condition and its impact on day-to-day clinical activities within the work environment. In particular we would like your supervisor to answer the following questions:

• are you aware of the application made by your candidate for reasonable adjustments?
• do you support your candidate's requested reasonable adjustments?
• what is the diagnosis or condition your candidate has?
• do you think this diagnosis or condition has an impact on your candidate day-to-day working in practice?
• if yes, can you detail what impact you or the team have observed. It would be helpful to know the impact on the following:
  • communication with patients and colleagues
  • use of IT equipment in practice for consultations, referrals, prescribing and reading hospital letters, time management and organisation, engagement with e-portfolio
• is there anything else you would like us to know which might help us come to a fair decision?

You can also supplement the above information, where appropriate, with a letter from your training programme. This could be a letter from the TPD, Occupational Health or Professional Support Unit. Please note that this information should be in relation to your application for reasonable adjustments only.

Disability assessment funding

Fees for professional assessments are the candidate's responsibility.

In some areas the Deanery funds dyslexia assessments for candidates, but this is not universal. Please note that the Exams Team are unable to advise on Deanery funding.

To process your reasonable adjustments in time for the examination, we recommend that you complete your online form and submit supporting evidence while in ST1 or as soon as you have a new diagnosis. The online form and supporting evidence (when available) must be submitted as soon as possible and no later than 15 working days before the booking window.

Once reasonable adjustments have been approved for an examination, they will continue to be applied to subsequent sittings of that examination. You do not need to apply again but should notify us if your circumstances change.

Please note that reasonable adjustments are not transferable between examinations, so you need to apply for the AKT and SCA separately.

Candidates who are waiting for an assessment, report or supporting evidence must ensure that it is submitted before the deadline (15 working days before the booking window) for the examination diet they wish to sit. Unfortunately, exceptions cannot be considered.

Here are the different steps from when you submit your reasonable adjustment request to the exam day:

Step 1: Complete the reasonable adjustment online form with all relevant information and email your supporting evidence to exams.accoms@rcgp.org.uk as soon as possible and before the deadline (see deadline dates at the top of the page). The deadline for submission of the online form and supporting evidence is at least 15 working days before the booking window of the exam you intend to sit in.

Step 2: The reasonable adjustments request is reviewed.

Step 3a: If your reasonable adjustment is not complex, we will send you a confirmation of your approved reasonable adjustments within 10 working days of receiving your Application Form and Supporting Evidence.

Step 3b: If your reasonable adjustments are complex, we will let you know of this within 10 working days. Complex reasonable adjustments may take up to 28 working days to be processed from the date we received your Application Form and Supporting Evidence.

Step 4: Apply for your examination. In the booking page make sure you select your disability and/or tick the box if you are pregnant.

Step 5: Your reasonable adjustment for the examination diet you have booked for will be sent to the external stakeholder who delivers your exam - a week after the booking window closes.

Step 6: The external stakeholder who delivers your exam will apply your approved adjustments to the system.

For the AKT, reasonable adjustments such as extra exam time, extra breaks, separate room, adjustable contrast and font and reader may mean that you will receive one email cancelling your booking and another email confirming the booking with the relevant reasonable adjustment added to it.

Step 7: Examination day - your approved adjustments will be delivered in your examination.

Candidates who are unable to meet deadlines for submission of requests (see deadlines at top of the page) can choose to sit at a later date or book and take the examination without adjustments.

Changes to your reasonable adjustments

Once approved, the reasonable adjustments will apply to all subsequent sittings of the AKT or SCA.

It is your responsibility to notify the RCGP of changes to these requirements.

SCA only - you are required to confirm at the point of booking your examination that there are no changes to your reasonable adjustment requirements.

Requests to change reasonable adjustments will be considered through the process for new requests as above, inclusive of all timelines.

Repeat exams

If you are unsuccessful in an examination and are subsequently diagnosed with a disability (such as a specific learning difficulty) then you will be entitled to reasonable adjustments for any future attempts. However, your unsuccessful attempt(s) will still stand.

We recommend, if you are unsuccessful in an examination and feel that your performance may have been impaired by an underlying disability, that you seek further advice after an initial attempt rather than waiting until you have been unsuccessful at the examination a number of times.

Candidate can apply for reasonable adjustments as per the reasonable adjustments policy (PDF file, 587 KB). Candidates submit any relevant supporting evidence which may include a Psychology assessment report for Neurodiversity, or a GP/Hospital specialist report detailing any medical condition.

Candidate applications for reasonable adjustments will be assessed on a case-by-case basis.

The College Disability Adviser is a practising GP and MRCGP examiner with experience in supporting candidates needing reasonable adjustments at their workplace.

Examples of reasonable adjustments for the AKT are:

• additional exam time
• additional breaks - the clock will not stop, and the candidate will have to manage their breaks themselves
• permission to access snacks (please note that this needs to be shown in the supporting evidence)
• wheelchair access
• separate room (only if referred to in supporting evidence) - please note that these are not soundproofed.
• permission to bring coloured overlay and fixative e.g., blu-tack
• adjustable contrast and font (font size, background colour, text) - this will be added to your exam, and you can make the adjustments to suit your needs
• reader
• paper exam

Examples of reasonable adjustments for the SCA are:

• additional reading time before each case
• additional consultation time
• additional rest breaks

For certain applications, the examinations team, on advice of the Disability Adviser, may ask the candidate to seek further supporting evidence or clarification from the educational supervisor or the local training scheme.

This information should highlight the condition and its impact on day-to-day clinical activities within the work environment. We would like the Educational Supervisor to answer the following questions:

• are you aware of the application made by your candidate for reasonable adjustments?
• do you support your candidate's requested reasonable adjustments?
• what is the diagnosis or condition your candidate has?
• do you think this diagnosis or condition has an impact on your candidate's day-to-day working in practice?
• if yes, can you detail what impact you or the team have observed. It would be helpful to know the impact on the following:
  • communication with patients and colleagues
  • use of IT equipment in practice for consultations, referrals, prescribing and reading hospital letters, time management and organisation, engagement with e-portfolio)
• is there anything else you would like us to know which might help us come to a fair decision?

Candidates can supplement the above information, where appropriate, with a letter from their training programme. This could be a letter from the TPD, Occupational Health and Professional support unit.

Before reading the list below, please visit the Comfort Aid List from Pearson VUE (external PDF). This provides all the items that you are allowed to take into a Pearson VUE Test Centre without needing pre-approval.

Water is allowed in the testing area but must be in a clear (free of labels) and resealable container with a sports cap, of no more than 750ml, which will be subject to visual inspection by an invigilator prior to being taken into the testing room.

Ergonomic chairs - Most Pearson VUE Test Centres have ergonomic chairs as standard, however specific seating cannot be guaranteed due to facilities varying across sites. Please contact exams.accoms@rcgp.org.uk after you have booked your test centre when we will be able to confirm your test centre’s seating arrangements.

When applying for reasonable adjustments, please only list the items/requirements from the list below or any others that are not on the Comfort Aid List.

Reasonable Adjustments available for the AKT

Please note that these reasonable adjustments will only be considered and approved if there is clear information about these in your supporting evidence.

• additional examination time*
• additional breaks* - the clock will not stop, and you will have to manage your breaks yourself
• permission to access snacks/drink (please note that this needs to be shown in your supporting evidence)
• wheelchair access
• separate room (only if referred to in supporting evidence) - please note that these are not soundproofed.
• permission to bring coloured overlay and fixative e.g., blu-tack
• adjustable contrast and font (font size, background colour, text) - this will be added to your exam, and you can make the adjustments to suit your needs.
• reader
• paper examination

*Please note that exams with extra time and additional breaks can only be sat in the afternoon sessions. Please make sure to book an afternoon session with Pearson VUE.

To apply for a reasonable adjustment for the AKT candidates must:

1. Submit an AKT request for reasonable adjustments online form
2. Submit supporting evidence of requested reasonable adjustments to exams.accoms@rcgp.org.uk

Please note that we need both the online form and the supporting evidence in order to be able to make a decision regarding your requests. If your supporting evidence is being submitted at a later date, please make sure it can be submitted before the deadline date, which is 15 working days before the booking window.

Candidates who are unable to meet deadlines for submission of requests (see deadlines at top of the page) can choose to sit at a later date or book and take the exam without adjustments.

Requests can be submitted at any point after starting training, or after a new diagnosis. We encourage candidates to submit their request as soon as possible.

For the October 2023 sitting, we will accept both the RA1 and the online form.

Information for pregnant candidates

Pregnant candidates who need drinks/snacks available during the exam and/or more frequent access to toilet facilities can apply for a rest break. The application process is identical to all other reasonable adjustment applications and supporting evidence will be required.

Please be advised that additional time is not granted as standard and is instead considered on a case-by-case basis. Decisions will vary according to the exact nature of the request.

If a pregnancy-related condition means that a pregnant candidate must cancel her AKT sitting at short notice then please refer to the cancellations and refunds policy.

Information for breastfeeding candidates

We fully appreciate that this is not ideal but are unable to support breastfeeding during the AKT exam.

Children are not permitted to enter Person VUE Test Centre premises and, due to the nature of the AKT being a high-stakes licensing examination, the RCGP does not permit candidates to leave the building while under examination conditions.

Information for breastfeeding candidates wishing to express/pump breast milk

Breastfeeding candidates wishing to express/pump breast milk during the examination can apply for a rest break and suitable space to do so during the examination. The application process is identical to all other reasonable adjustment applications and supporting evidence will be required.

All Pearson VUE Test Centre sites have different layouts and so accommodation requests may require the candidate to schedule their examination at a different Pearson VUE Test Centre to their preferred location. There may be no appropriate separate rooms available at the Pearson VUE Test Centre of choice.

Please ensure to apply for any reasonable accommodation as early as possible.

The MRCGP consists of two examination-based and one workplace-based assessment components. All three components need to be passed for a candidate to be considered to have satisfactorily completed specialty training for general practice and being competent to enter independent practice in the United Kingdom without further supervision. Satisfactory completion of the MRCGP is a pre-requisite for the issue of a certificate of completion of training (CCT) by the General Medical Council and full Membership of the RCGP.

The two examination-based components are the Applied Knowledge Test (AKT) and the Simulated Consultation Assessment (SCA). It is for these two components that candidate often seek reasonable adjustments for an underlying disability. In order for you to be able to tailor your recommendations to the demands of the examinations we would appreciate it if you could take the time to read these short guides, which will hopefully increase your understanding of what they involve.

The AKT is a multiple-choice examination that tests the candidate's application of knowledge and is normally taken prior to the Simulated Consultation Assessment (SCA). It is computer-delivered in Pearson VUE professional testing centres across the four nations. The examination contains 200 questions, and the standard time allocation is 3 hours and 10 minutes.

There are a number of different formats to the questions:

• Single best answer (SBA)
• Extended matching questions (EMQ)
• Picture/table/chart format
• Data interpretation
• Free text

You can find examples of these on the candidate AKT presentation (PDF file, 1.6 MB).

Some of the questions will involve interpreting information that will be displayed in a similar format to that seen regularly in common medical journals. Some may also require simple arithmetical calculations.

Examples of common reasonable adjustments that are made:

• additional examination time
• additional breaks - the clock will not stop, and you will have to manage your breaks yourself
• permission to access snacks/drink (please note that this needs to be shown in your supporting evidence)
• wheelchair access
• separate room (only if referred to in supporting evidence) - These are not soundproofed.
• permission to bring coloured overlay and fixative e.g., blu-tack
• adjustable contrast and font (font size, background colour, text). This will be added to your exam, and you can make the adjustments to suit your needs.
• reader
• paper exam

Some questions that are commonly raised about reasonable adjustments:

Provision of a paper version of the examination

Reasonable adjustments must be proportionate, and the routine provision of paper examinations is challenging, particularly as some question formats are specifically designed for computer-based delivery and marking. It should also be remembered that GPs are required to use computer-based medical records on a daily basis and so a candidate who requests a paper version would need to be able to demonstrate what adjustments had been made for them in the workplace to accommodate this.

Decisions are made on a case-by-case basis and, in exceptional circumstances, a paper version of the AKT may be provided and sat at the RCGP, 30 Euston Square, London. Pearson VUE cannot accommodate paper examinations.

Provision of more than 25% additional time

For specific learning difficulties, such as dyslexia, the RCGP, in line with current national practice, routinely offers an additional 25% time. This is almost always justified by the supporting professional evidence and adequate to ensure a level playing field with other candidates. The RCGP has a responsibility to ensure that candidates with a specific learning difficulty are supported and are not disadvantaged due to their disability, however it also has the responsibility of making sure that such a candidate does not receive any unfair advantage over other candidates. The standards expected of a high stakes national licensing exam such as the AKT cannot be compromised for reasons of patient safety.

In order to consider more than 25% additional time, the RCGP would need to see more supporting evidence. The RCGP must be able to clarify what impact the learning difficulty is having on day-to-day functioning and what adjustments are in place to support the candidate within their usual workplace.

We would only accept more than 25% additional time under exceptional circumstances where significant workplace adjustments have been made to accommodate the learning difficulty. Such significant additional time can make examinations last more than five hours, which some candidates could then find very tiring.

It is worth remembering that candidates often find other adjustments helpful, such as screen overlays, background colour changes and font size changes etc. These, along with the 25% additional time, are more than sufficient for the vast majority of applicants.

Provision of extra time for candidates for whom English is an additional language

This section is relevant when considering English for Speakers of other languages (ESOL).

Candidates with a specific learning difficulty are entitled to additional time in the examination, provided that they submit a report from an educational/chartered psychologist or an appropriately qualified specialist teacher (PATOSS) which endorses this.

This assessment needs to be in English and be undertaken post-16 years of age. If it involves a candidate for whom English is an additional language then you, as the assessor, need to include details of your experience in assessing individuals with this characteristic.

If one of your recommendations is for additional time, then it needs to be clear that this is due to the candidate's underlying disability (as defined by the Equality Act 2010) rather than the fact that English is an additional language.

Use of text-to-speech software or a reader

The RCGP is not able to offer the use of text-to-speech software as an adjustment. This is due to practical reasons, including the use of pictures and graphs, the use of medical terminology and the security considerations of Pearson VUE centres in allowing additional software to be added to their computer systems.

In exceptional circumstances the use of a reader may be available. However, this would require the candidate to demonstrate a genuine need and in this regard, we would expect that they could demonstrate the regular use of an adjustment of this kind, or a comparable adaptation, within their workplace.

Before completing your online form with your adjustment requests for the SCA, please check the SCA comfort aid list. The SCA Comfort Aid List has a list of items you may bring into your exam without pre-approval from the RCGP. Please make sure that you check with the Surgery/Practice in advance of your examination, if relevant.

Reasonable Adjustments available for the SCA

• additional reading time before each case
• additional consultation time
• additional rest breaks

The SCA will examine your ability to integrate and apply clinical, professional and communication skills appropriate for General Practice.

The SCA will involve twelve consultations with simulated patients, each lasting twelve minutes.

The cases are performed by professional role-players who are trained, calibrated, and standardised so that although the case appears the same for every candidate, it responds to the approach of each individual doctor, as in real life.

The cases may be patients (most commonly), or their carer/parent or other health or social care workers. In the majority of the cases, you will be able to see the simulated patient. Others will be audio only. There will be a 3-minute gap in between cases.

Physical examination will not be assessed within the SCA, and instead will be covered within WPBA.

You will take the SCA in a local GP surgery via an online IT platform. In most cases this will be your own surgery or an alternative similar venue.

The entire examination will be recorded remotely and will be viewed and marked at a later date by examiners. Each of the twelve cases will be independently marked by a different examiner.

In addition to personal workplace-based adjustments all candidates will benefit from the accessibility features of the Osler examination platform. Which include:

• keyboard navigation
• enlargement/zooming of instructions

To apply for a reasonable adjustment for the SCA candidates must:

1. Submit an SCA request for reasonable adjustments online form
2. Submit supporting evidence of requested reasonable adjustments to exams.accoms@rcgp.org.uk

Please note that we need both the online form and the supporting evidence in order to be able to make a decision regarding your requests. If your supporting evidence is being submitted at a later date, please make sure it can be submitted before the deadline date, which is 15 working days before the booking window.

Candidates who are unable to meet deadlines for submission of requests (see deadlines at top of the page) can choose to sit at a later date or book and take the exam without adjustments.

Requests can be submitted at any point after starting training, or after a new diagnosis. We encourage candidates to submit their request as soon as possible.

The MRCGP consists of two exam-based and one workplace-based assessment components. All three components need to be passed for a candidate to be considered to have satisfactorily completed specialty training for general practice and being competent to enter independent practice in the United Kingdom without further supervision. Satisfactory completion of the MRCGP is a pre-requisite for the issue of a certificate of completion of training (CCT) by the General Medical Council and full Membership of the RCGP.

The two exam-based assessment components are the Applied Knowledge Test (AKT) and the Simulated Consultation Assessment (SCA). It is for these two components that candidates often seek reasonable adjustments for an underlying disability. In order for you to be able to tailor your recommendations to the demands of the assessments we would appreciate it if you could take the time to read these short guides, which will hopefully increase your understanding of what they involve.

The Simulated Consultation Assessment (SCA) is a new examination which will replace the Recorded Consultation Assessment (RCA) which was developed during COVID-19.

Candidates will take the SCA in a local GP surgery via an online IT platform. In most cases this will be a candidate's own surgery and hence it would be expected that any reasonable adjustments required to enable their day-to-day work (such as special seating, aids, IT equipment and software etc.) would already be in place. Physical examination will not be assessed within the SCA, and instead will be covered within WPBA.

Applications for reasonable adjustments will be assessed on a case-by-case basis. In addition to the Disability Assessors report, candidates may need to submit supporting evidence from their Educational Supervisor and or hospital specialist reports.

Examples of reasonable adjustments for the SCA are:

• additional reading time before each case
• additional consultation time
• additional rest breaks

The Equality Act 2010 requires that employers make reasonable adjustments to make sure workers (including candidates) with disabilities, or physical or mental health conditions, are not substantially disadvantaged while doing their jobs.

As WPBA evaluates the candidate's progress in areas of professional practice best tested in the workplace, reasonable adjustments relating to WPBA are a matter for either your employer, or the deanery, please discuss reasonable adjustment requests with them.

Similarly, if you think you may need reasonable adjustments to help you meet the requirements of the Curriculum, please discuss this with your employer or your deanery. If a reasonable adjustment is made that relates to WPBA, this should be recorded in an Educator Note on the Trainee Portfolio.

Reasonable adjustments primarily enable a candidate with a disability or temporary medical condition to overcome barriers that prevent them from accessing an assessment, so that they can demonstrate their knowledge and skills without affecting the competence standards.

There are a few examples below of reasonable adjustments that have been put in place for GP registrars - though it's important to note that these examples will not automatically be considered reasonable in all cases, as each reasonable adjustment request will be considered on a case-by-case basis.

Dictation and speech recognition

Many smartphones, tablets and laptops have built-in dictation and speech recognition software which can help when writing portfolio entries. The Clinical Case Review section of the Trainee Portfolio includes guidance on how to use inbuilt device dictation software to help add reflections.

Similarly, another approach could be to avoid penalties for poor spelling, grammar, punctuation, syntax, or structure where the meaning is clear.

Completing CEPS

The CEPS section of the WPBA assessment page has some guidance for candidates who may find it difficult to complete CEPS.

One approach could involve a candidate who cannot physically carry out an examination referring the patient to a colleague, instructing the colleague to examine the patient appropriately, and then interpreting the findings having communicated with the colleague who carried out the examination.

Breaks and timings

Consider rest or toilet breaks during a relevant WPBA (e.g. CAT) or during a teaching session, or providing opportunities to eat, drink or use insulin, medication, eye drops or inhaler. The time of day that WPBAs or teaching sessions take place could be adjusted as well.

When asking questions, allow the respondent sufficient time to think before inviting an answer.

Further information

The GMC has guidance on reasonable adjustments that organisations can make for learners.