The company was also taken to task in 2015 by John Oliver in a segment on his satirical news program Last Week Tonight that tore down the state of standardised testing in the US. Monday's RACP Basic Training Test, the culmination of 12 months to two years of intensive study for registrars preparing to specialise in either paediatrics or adult medicine, was cut short following an "unknown technical fault", forcing them to sit through the high-stress ordeal again next month. It was the first time the exam was computer-based. Registrars and senior physicians are outraged the RACP went ahead with the change despite Pearson's poor record and a list of concerns raised months ago about the software and proposed examination process. Concerns raised months ago A letter obtained by Fairfax Media shows registrars alerted the RACP to numerous concerns about the switch to the computer-based exam, after trialling Pearson's software using a sample exam.

In addition to fears the changes would impact trainees' already strained mental health, their concerns included the apparent lack of testing or feedback regarding the use of Pearson's software for medical and clinical exams. "Looking online, we have not found any forums with customer feedback regarding the ease of use of Pearson VUE for medical/clinical examinations. The fact that we are trialling a new system in such an important examination is of concern," the letter read. The registrars had also requested reassurance that an appropriate plan would be in place in the event of a computer malfunction. "Candidates would like to be reassured of the process for when a computer error occurs (eg.

power failure, or program malfunction etc). How will their results be stored, timing impacted, and

is there an alternative back-up if the computer system fails? "Plans for this process need to be put in place prior to the examination, so that the process is transparent and that the exam can be standardised across different centres."

There was lack of proper security and professionalism displayed by Pearson staff overseeing the test, several candidates told Fairfax Media. One registrar said his test started 20 minutes late, and that he was told some exam rooms had little to no supervision. During his break between the two halves of the exam, he said he was waiting in a room with candidates who had completed both halves. All students had their phones with them, he said, until about 30 minutes later when an announcement went out that their phones should be off. “The integrity of the exam was gone there and then, even leaving aside the fact that this computer malfunction happened and we weren't actually able to finish the exam,” he said. When candidates were informed they could “go home” due to the computer error, there was no acknowledgement of their distress, he said. “The man even said to us when he said we could leave, 'oh, the good news is you'll be early for happy hour'. Which just shows that they didn't understand the magnitude of this exam for the thousands of uni doctors who were sitting it.”

Pearson Australia declined repeated requests for comment and directed all queries relating to Monday's exam to the RACP. Senior physician Ian Kerridge rebuked the college for contracting a company with a track record of failures. "How on earth did the college commission a group who has been incompetent in the past to handle such a critical exam?" he said. Professor Kerridge said there needed to be a full and independent review into the RACP's processes. He said the college must provide a compassionate response for registrars that took into account the significant impact of the debacle, and consult with those affected about how to progress their training without causing further harm.

Professor Kerridge also reiterated his call for the RACP's president, CEO, president-elect and chair of the education committee to stand down. An RACP spokesman said: "There were significant checks and balances in place with Pearson Vue, and testing included delivery in a production environment. We have had trainees participate in sample testing since August 2017." RACP president Catherine Yelland told Fairfax Media she had not been aware of Pearson’s poor track record prior to Monday’s meltdown, but that “Because of the size and the extent of the examination, there are only a limited number of providers” in the area; and “as I understand it, Pearson VUE was really the only provider that could do this.” Dr Yelland said on Tuesday the RACP had given Pearson 48 hours to report on how the error occurred, and that she and the CEO would meet with the company next week. “We also understand there are a whole lot of other questions the trainees have around the whole conduct of the examination," she said. "As well as getting a report from the examination centre, we will conduct our own internal review of the whole process. We are setting that up as soon as we can.”

'A rotten stressful time' With the back-up paper exam set for March 2, Health Minister Brad Hazzard has asked all NSW public hospitals to make allowances for the roughly 250 registrars working in the state’s public hospitals affected by the botched exam. “I sent a clear message to the chief executives to recognise the stress and pressure these young doctors will be under and do what they can to help,” Mr Hazzard said. “We need to make sure they are all singing off same song sheet when it comes to ensuring these doctors get the support they need as they head towards the next exam. “It clearly is a disaster for the young doctors. This is a really terrible time for any young doctor even without an exam going bottoms up.

“It is just a rotten, stressful time.” Two young registrars studying for the 2016 RACP exam killed themselves during the intensive study period, including Chloe Abbott. “To our young doctors, I’d say it is tough. You’ve all got other personal parts of life that probably make it more complex but just keep in mind that the government is saying to NSW Health we want to help you and do whatever we can to make it less difficult,” Mr Hazzard said. “Keep calm, and know that there are people in the system who are backing you and will be asking the college to do its bit, and also all of the health bureaucrats right across NSW, to help you out.” Mr Hazzard said he had yet to speak to the RACP, but that the college needed to look for long-term solutions, including holding the exam twice yearly to give registrars a second chance and more flexibility.