1. Society for Academic Primary Care
ASM 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

2. 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 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).

3. 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.

4. 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.

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

6. -- 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.

7. Descriptive CaHRU@lincoln.ac.uk Candidate characteristics2
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

8. 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.

9. 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.

10. 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.

11. 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.

12. 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.

13. 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.

14. 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.

15. Conclusion
We found no evidence that the AKT accommodation unfairly discriminated against candidates who declared dyslexia.

16. 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.

17. Acknowledgments
Royal College of General Practitioners for providing data.
Prof. Niro Siriwardena for the original idea and guidance.