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BMA calls for urgent review of online exam for medical students

BMJ 2021; 372 doi: (Published 27 January 2021) Cite this as: BMJ 2021;372:n253

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We need to move towards a student-centred application process for foundation training

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Re: BMA calls for urgent review of online exam for medical students

Dear Editor

This article highlights the concerns the BMA have on the impact of final year medical students. This has indeed been a year of uncertainty for medical students across the UK and reading this article has made me reflect on how COVID has shaped our last 12 months in full-time education before starting as junior doctors. The issues surrounding the SJT (Situational Judgement Test) were not in isolation, as many other incidents this year have been a source of apprehension and stress. Although this is just one exam, the cumulative effect should be considered.

As final year medical students, the SJT counts for half of our final EPM (Educational Performance Measure) which dictates the deanery and job we will be allocated after graduating (1). To see 20 students wrongly disqualified from such a seminal exam is both unnerving and shocking. To read the justification given that these 20 students equated to a very small percentage overall I feel takes away from the gravity it will have on each individual. No matter how few, no-one should have been subjected to this experience.

Last year, at the peak of the first wave, thousands of almost qualified final year medical students were fast-tracked through graduation to commence their role as FY1 doctors (2). As a 4th year student, the first wave bought my placement completely to a halt as we were shifted to self-directed, online learning. Almost a whole year later, our education had gone through several transformations- from volunteering in HCA roles and in COVID testing centres to returning to placement with the new PPE guidance and adapting to a constantly changing exam platforms (3). We are constantly balancing the risk from exposing ourselves at placement in hospital environments with the need to prepare ourselves for clinical practice in less than 6 months’ time (4). Exams setups have been unreliable, with last-minute changes and a plethora of problems due to new reliance on technology and Wi-Fi. Some exams have even been cancelled all together. All the uncertainty and changes have added both physical and mental challenges to students already navigating their way through a global pandemic (5).

With many more exams to undertake before graduating, it is not only the immediate logistical challenges that could affect us, but the long term implications to our confidence as newly-qualified clinicians (6). One study from June 2020 reported cancelled OSCEs, postponed placements and cancelled electives each had a significant effect on student’s preparedness starting work last August (7). Retrospectively, the students who graduated summer 2020 experienced less disruption than the current students, suggesting even greater effects for this years’ graduating cohort. Many studies have found FY1 doctors felt underprepared pre-COVID, but with the augmentation of a disruptive final year and the high-pressure environment we will be entering, I feel more support is needed for students (8).

I think it is important to pinpoint ways in which students can be supported during this time and this article, highlighting the issues with how the SJT was ran, shows there is more work to be done. With further exams this year it is increasing important that welfare of medical students is a priority.


1. UK Foundation Programme. 2021. How is the SJT scored? - UK Foundation Programme. [online] Available at: [Accessed 1 February 2021].
2. Iacobucci, G., 2020. Covid-19: medical schools are urged to fast-track final year students. BMJ, p.m1064.
3. Wang, J., Tan, S. and Raubenheimer, K., 2020. Rethinking the role of senior medical students in the COVID ‐19 response. Medical Journal of Australia, 212(10), p.490.
4. Gill, D., Whitehead, C. and Wondimagegn, D., 2020. Challenges to medical education at a time of physical distancing. The Lancet, 396(10244), pp.77-79.
5. Chandratre, S., 2020. Medical Students and COVID-19: Challenges and Supportive Strategies. Journal of Medical Education and Curricular Development, 7, p.238212052093505.
6. Choi, B., Jegatheeswaran, L., Minocha, A., Alhilani, M., Nakhoul, M. and Mutengesa, E., 2020. The impact of the COVID-19 pandemic on final year medical students in the United Kingdom: a national survey. BMC Medical Education, 20(1).
7. Rainbow, S. and Dorji, T., 2020. Impact of COVID-19 on medical students in the United Kingdom. Germs, 10(3), pp.240-243.
8. Monrouxe, L., Bullock, A., Gormley, G., Kaufhold, K., Kelly, N., Roberts, C., Mattick, K. and Rees, C., 2018. New graduate doctors’ preparedness for practice: a multistakeholder, multicentre narrative study. BMJ Open, 8(8), p.e023146.

Competing interests: No competing interests

03 February 2021
Hannah R Wise
Medical Student
Cardiff University, Cardiff