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Editor,—The London Apothecaries Diploma in Genitourinary Medicine is likely to become even more important in the near future as all specialist registrars and probably many non-consultant grades will be expected to pass it as part of higher training in the specialty in the United Kingdom. It would be interesting to have some figures on the number of candidates anticipated in the near future and how this will affect the examination mechanism.
The Apothecaries Diploma Board rejected viva voce examinations some time ago as being prone to bias. This is consistent with much current research on examination techniques.1 Oral examinations are regarded as being inherently biased and of poor interexaminer reliability. How much, however, is this also a candidate number related phenomenon? With courses for small numbers, such as the Diploma in Venereology and Genitourinary Medicine of Liverpool University, we find the viva a key mechanism to discriminate between candidates precisely because the examiner can adjust the level of difficulty of questions to the ability of each candidate. The viva is a good instrument to measure clinical thinking, ability to take a sexual history, and counselling. Role play need not be uniquely the province of actors. The viva is particularly useful for borderline candidates—for example, those who are disadvantaged in essays which are notoriously dependent on proficiency in English (not to mention handwriting!). In order to reduce interexaminer variation inherent in the viva, all candidates for the Liverpool Diploma are viva'd independently by both sets of (two) examiners. Clearly, this would be extremely cumbersome and time consuming for the current and anticipated numbers taking the Apothecaries Diploma.
The venerable Apothecaries' Hall is apparently “unsuitable” for projecting slides a convenient way of basing a clinical skills/data interpretation type examination for a large number of candidates—for example, MRCP Part 2 and many other postgraduate medical examinations. Will the examiners of the Apothecaries Diploma have to begin to think of more appropriate premises for their examination?