Society for Academic Primary Care ASM 2017 - Warwick 46th annual scientific meeting Performance of candidates with dyslexia in the Applied Knowledge Test for the Membership of the Royal College of GPs Dyslexia Study: Performance of candidates declaring dyslexia in the AKT for MRCGP Zahid Asghar1 Niro Siriwardena1 Larcombe J2, Elfes C2, Neden K2, Salim A2, Smalley D2, Richardson J2, Blow C2 1 University of Lincoln, 2 MRCGP CaHRU@lincoln.ac.uk

Background Dyslexia is a specific learning disability (SLD) primarily affecting skills in accurate and fluent word reading and spelling. 6 million people affected in UK. Very few studies have looked at performance of candidates with dyslexia in licensing examinations. Little is known about the relative performance of medical graduates with dyslexia in licensing examinations. SLD a general term for disorders that involve difficulty in learning to read or interpret words, letters, and other symbols, but obviously that do not affect general intelligence Equality Act 2010 eliminate unlawful discrimination , so licensing bodies must provide equality of opportunity and eliminate unlawful discrimination. AKT – component of medical licensing examination, high stakes computer based knowledge test Candidates can declare dyslexia and request appropriate test accommodations. Additional time is provided (Time +25%) (45 mins). CaHRU@lincoln.ac.uk

Background Lack of previous research is partly due to heterogeneity of candidates presenting with dyslexia and SLDs, small sample sizes, and variation in test accommodations. In our study we mitigate these problems by including 14 consecutive tests over a period of 5 years. Little is known about the relative performance of medical graduates with dyslexia in licensing examinations. CaHRU@lincoln.ac.uk

Aim To investigate performance of candidates who declare dyslexia with those who do not in the computer-based Applied Knowledge Test (AKT) component of the UK MRCGP licensing examination for general practice. AKT candidates who declare an expert confirmed diagnosis of dyslexia. CaHRU@lincoln.ac.uk

Inclusion-exclusion criteria Five years AKT results: 2010 - 2015 All specialty trainees in general practice We took Routinely collected Performance and demographics AKT data over 5 years. Included all specialty trainees CaHRU@lincoln.ac.uk

-- Method Descriptive statistics. Comparing candidates declaring dyslexia early vs. late. Multi-variate logistic regression to analyse the performance of the candidates adjusting for known confounders (e.g. age, sex, ethnicity, place of primary qualification). Descriptive stats – for the demographics and characteristics of the population. Further analysis of Early declarers vs late Multi-variate logistic analysis for predictors of passing the AKT. This is most suitable as candidates can declare dyslexia anytime during the study period.– Also marks needed to pass varied over duration of study period. CaHRU@lincoln.ac.uk

Descriptive CaHRU@lincoln.ac.uk Candidate characteristics 2 Candidate characteristics Dyslexia declared Dyslexia not declared χ   N=379 (2.6 %) N=14422 (97.4 %) Sex Female 199 (52.5) 9004 (62.4) p<0.001 Male 178 (47.0) 5388 (37.4) Age (years) Under 30 144 (38.0) 6750 (46.8) 30-39 174 (45.9) 6398 (44.4) 40-50 47 (12.4) 1132 (7.8) 51-80 11 (2.9) 109 (0.8) 2 2.6% of all candidates declaring dyslexia. Older males more likely to declare dyslexia CaHRU@lincoln.ac.uk

Descriptive CaHRU@lincoln.ac.uk Candidate characteristics Dyslexia declared Dyslexia not declared χ   N=379 (%) N=14422 Country of primary medical qualification UK 278 (73.4) 10879 (75.4) EU & Russia 27 (7.1) 580 (4.0) p=0.01 Rest of the World 73 (19.3) 2806 (19.5) Unknown 1 (0.3) 157 (1.1) Ethnicity White British 183 (48.3) 7161 (49.7) p=0.319 Asian 129 (34.0) 5044 (35.0) Black 20 (5.3) 765 Mixed 12 (3.2) 360 (2.5) Other 239 (1.7) 23 (6.1) 853 (5.9) 2 UK , EU & Russia were the countries of primary medical qualification more likely to declare dyslexia. Ethnicity was not statistically significant. CaHRU@lincoln.ac.uk

Descriptive CaHRU@lincoln.ac.uk Candidate characteristics Dyslexia declared Dyslexia not declared χ   N=379 (%) N=14422 Number of attempts First 192 (50.7) 11727 (81.3) p<0.001 Second 53 (14.0) 1668 (11.6) Third 52 (13.7) 649 (4.5) Fourth 42 (11.1) 266 (1.8) >=5 40 (10.6) 112 (0.8) Stage of training ST2 28 (7.4) 1232 (8.5) p=0.052 ST3 86 (22.7) 2232 (15.5) ST4 1 (0.3) 37 Missing 264 (69.7) 10921 (75.7) 2 Candidates who declared dyslexia were likely to have more attempts at the AKT. Stage of training was not significant. CaHRU@lincoln.ac.uk

Descriptive: dyslexia declared early vs late Candidate characteristics Dyslexia declared early  Dyslexia declared late    N =239 (63.1%) (%) N=140 (36.9%) χ Examination outcome Pass 210 (87.9) 107 (76.4) p<0.01 Fail 29 (12.1) 33 (23.6) Ethnicity White British 159 (66.5) 24 (17.1) p<0.001 Asian 54 (22.6) 75 (53.6) Black 4 (1.7) 16 (11.4) Mixed 7 (2.9) 5 (3.6) Other 3 (1.3) 9 (6.4) Country of primary medical qualification UK 224 (93.7) (38.6) Rest of the World 10 (4.2) 63 (45.0) EU & Russia 23 (16.4) 2 Candidates declaring dyslexia late in a simple comparison, i.e. after failing at least one AKT were more likely to fail, to be BME and overseas trained. CaHRU@lincoln.ac.uk

Descriptive: passing candidates Candidate characteristics Dyslexia declared Dyslexia not declared χ   N=317 (83.6%) N=13702 (95.0%) Sex Female 170 (53.6) 8,636 (63.0) p<0.001 Male 147 (46.4) 5,066 (37.0) Age (years) Under 30 135 (42.6) 6,617 (48.3) p<0.01 30-39 141 (44.5) 6,018 (43.9) 40-50 32 (10.1) 979 (7.1) 51-80 8 (2.5) 85 (0.6) 2 Passing candidates declaring dyslexia were more likely to be male and older. CaHRU@lincoln.ac.uk

Descriptive: passing candidates Candidate characteristics Dyslexia declared Dyslexia not declared χ   N=317 (%) N=13702 Ethnicity White British 168 (53.0) 7,036 (51.4) P=0.78 Asian 101 (31.9) 4,642 (33.9) Black 12 (3.8) 668 (4.9) Mixed 10 (3.2) 348 (2.5) Other 7 (2.2) 219 (1.6) Unknown 19 (6.0) 789 (5.8) Number of attempts One 181 (57.1) 11,379 (83.0) p<0.001 2-3 80 (25.2) 2,045 (14.9) ≥4 56 (17.7) 278 (2.0) 2 83.6% vs 95% pass rate Candidates who declared dyslexia took more attempts at passing the AKT. CaHRU@lincoln.ac.uk

Regression Results CaHRU@lincoln.ac.uk Candidates characteristics Coefficient 95% confidence interval p-value Number of examination attempts 1 Reference 2-3 -0.68 (-0.98 to -0.38) <0.001 4+ -0.81 (-1.26 to -0.36) Ethnicity White British Asian -1.22 (-1.55 to -0.89) Black -1.36 (-1.85 to -0.87) Mixed -0.25 (-1.13 to 0.62) 0.57 Other -1.64 (-2.36 to -0.92) Country of primary medical qualification UK Rest of the World -0.39 (-0.72 to -0.06) 0.02 EU & Russia -0.69 (-1.18 to -0.21) 0.005 Multi-variate logistic regression showing factors associated with passing the AKT More likely to PASS AKT at first attempt if the candidates are Young (<30) , WHITE British, and Qualified from UK. CaHRU@lincoln.ac.uk

Regression Results CaHRU@lincoln.ac.uk Candidates characteristics Coefficient 95% confidence interval p-value Age (years) <30 Reference 30-39 -0.65 (-0.96 to -0.35) <0.001 40-50 -1.20 (-1.63 to -0.76) 51-80 -1.96 (-2.91 to -1.02) Time taken < 3hrs = 3hrs (-0.03 to 0.02) p=0.78 > 3hrs -0.09 (-0.12 to -0.06) p<0.001 Dyslexia declared or not declared Dyslexia not declared   Dyslexia declared -0.29 (-1.04 to 0.47) p=0.46 Less likely to PASS even with Extra time accommodation, dyslexic status (early or late) not statistically significant. CaHRU@lincoln.ac.uk

Conclusion We found no evidence that the AKT accommodation unfairly discriminated against candidates who declared dyslexia. CaHRU@lincoln.ac.uk

Why are the candidates not declaring dyslexia early? Further Research Background: Epilepsy Why are the candidates not declaring dyslexia early? Qualitative research could help to fill the gaps. CaHRU@lincoln.ac.uk

Acknowledgments Royal College of General Practitioners for providing data. Prof. Niro Siriwardena for the original idea and guidance. www.lincoln.ac.uk