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Doctors share anguish over prolonged suspension of Council exam

International doctors living in Ireland have spoken to the Medical Independent (MI) about their deep upset and frustration waiting for the Medical Council to resume a key exam required for registration, which has been suspended since March 2020 following the onset of Covid-19.

PRES 3 assesses clinical skills and is a requirement for many international medical graduates seeking general registration with the Irish Medical Council (IMC), with some exemptions. The exam, which usually takes place two-to-three times a year, is conducted by medical schools in Ireland on behalf of the Council. The practical assessment involves simulated patients or anatomical models in a variety of simulated clinical situations.

According to the Council, there are 188 applicants who are eligible to sit the PRES 3, of whom 66 eligible candidates currently have an address in Ireland

MI understands that many of the doctors already resident in Ireland have spouses working in the Irish health service. They have been unable to take up employment as doctors in the health service– including vaccinator posts.

A large group of international doctors joined an online interview with MI to discuss the issue.

Reflecting the feelings of many of the doctors, Dr Fouzia Taimoor stated: “I feel like they [Medical Council] don’t have any will to do something for us, and it has impacted us mentally to quite an extent.”

Dr Taimoor said the doctors feel “devasted, ignored and discriminated, to be honest”.

The doctors pointed out that medical regulators in other jurisdictions have found solutions to the hosting of these exams during the pandemic.

The UK General Medical Council (GMC) confirmed to MI that its clinical skills exam – PLAB 2 – had been restored since August 2020.

“Our assessment centre in Manchester had to remain closed for four months last year, until August 2020. Following that we continued to run PLAB 2 exams during the UK lockdowns with stringent hygiene and social distancing measures in place,” a GMC spokesperson told MI.

“As we were only able to operate at half capacity, due to social distancing requirements, we carefully prioritised re-allocating PLAB spaces when we restarted exams in August 2020, including for doctors who had exams cancelled, refugee doctors, and those with job offers.”

The GMC spokesperson added: “In June 2021 we created a new PLAB 2 temporary assessment centre to boost numbers, utilising space created from current homeworking arrangements. The temporary centre has allowed us to return our overall capacity to pre-Covid levels, allowing us to test 11,000 doctors each year.

“Steps we’ve taken to protect candidates, colleagues, role players and examiners include staggered arrival times, mandatory face coverings and clear floor markings around the centre. The temporary assessment centre was specifically designed to enable social distancing.”

The GMC spokesperson said the regulator was “not aware of any increase in Covid cases in those who have attended or worked in the assessment centre. At no point have we had an outbreak in the centre.”

The Irish Medical Council has repeatedly said that resumption of PRES 3 is dependent on getting the go-ahead from the medical schools. MI understands the Deans of the medical schools were due to meet recently and this issue was on the agenda.

Dr Sathika Navaratna, whose husband works as a doctor in the Irish health service, said the group was calling on the Council to urgently adapt to the “new normal” by sourcing alternative venues or recognising comparable international clinical exams (such as the GMC’s PLAB 2) as satisfactory. 

“Most of the registration exams held in different parts of the world, in different countries, have provided doctors with options,” she commented.

“The advantage in Ireland is we have a good vaccination programme and most of us are vaccinated, and I am sure the examiners are as well.”

She drew attention to the fact that individual training in gyms and indoor service in pubs have been permitted for several weeks.

Dr Apoorva Gopinath was scheduled to take PRES 3 in March 2020. Dr Gopinath said she fully understood the initial suspension amid the huge uncertainty at the start of the pandemic.

“They said they would come back with a date when it was possible. At that point of time, no-one knew Covid would go on for this long.”

Despite “repeated emails” to the Council, she said the same “copy and paste” response has been issued to affected doctors.

“We have patiently waited for a long time and it has affected a lot of our mental health as well,” confirmed Dr Navaratna. “These are minds and hands they can use, most of my colleagues have specialisations but are waiting in Ireland without registration. It is quite a pathetic situation.”

Her colleague Dr Taimoor underlined that “where there is a will, there is a way”, when it comes to finding a solution.

She added: “Many of us have moved to the UK but we want to live here, we want to practice here, we have families here, and that is the reason we are waiting here patiently. But every time you call the IMC, they will give you the same answer. It seems like they don’t want to do anything for us, no-one is listening to us, we are just frustrated and hopeless.”

Dr Prasanna Kanagaratenam noted that many doctors in Ireland waiting to take PRES 3 have “years of experience” in their native countries, yet the Irish health system is recruiting “fresh graduates” from non-EU countries.

The doctors drew attention to the shortage of medical professionals in Ireland and gaps in the rotas due to lack of SHOs and registrars across hospitals.

In an update this afternoon, a Medical Council spokesperson informed MI: “Traditionally the PRES 3 exams have been hosted on behalf of the Medical Council by the medical schools, however, due to the pandemic, the PRES 3 exams scheduled to take place in March 2020 were postponed and it has not been possible to reschedule the exams since.

“The Medical Council has had discussions with the Medical Schools Council on numerous occasions since March 2020 to explore the possibility of running the PRES 3 exams but due to the ongoing implications of the pandemic, multiple waves of Covid and resulting public health restrictions, the medical schools did not feel they could safely host the exams for the Council.

“The Council is in regular contact with the Medical Schools and the Medical Schools Council and the matter is being followed up as a matter of urgency to be able to offer the PRES 3 at the earliest opportunity. It is envisaged that with the support of the Medical Schools Council, a date for the exams will be confirmed in the very near future.

“Overall there are 188 applicants who are eligible to sit the PRES 3, of which 66 eligible candidates currently have an address in Ireland. The Medical Council is committed to resuming these exams as soon as possible.”

This newspaper also queried the Department of Health and HSE on the matter and awaits their responses.

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