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Gold, incentives and meh

Ruth Lockley

  • Exclude unvaccinated children from school during measles outbreaks, recommend public health experts

    Ruth Lockley's comment 14 Nov 2013 9:33am

    @9:12am You wil find the figure you want on Page 19 of the document available on
    http://www.wales.nhs.uk/sitesplus/888/news/29688
    In this outbreak 2 doses of MMR were 99% effective at preventing infection and 1 dose 97% effective. If you go to the page I have given above you can see the actual figures and more discussion as to how they were collected. Hope that's what you wanted.

  • MRCGP examiners 'do not favour their own', claims study

    Ruth Lockley's comment 14 Oct 2013 2:00pm

    11.56am, not sure if the info you wanted is on Table 1, which shows the number of examiners from BME and the number of examiners who were IMGs.

    My reason for posting is actually another question to anyone who has looked at the methods for this and Prof Esmail's paper. I'm assuming that the datasets they used overlap significantly, but this set of researchers apparently only failed to assign ethnicity to candidates in 29 out of 4029 attempts, whereas Prof Esmail's group had data on 5094 candidates of which 489 did not provide sufficient data for categorisation and another 61 had data missing, so 550 were excluded from analysis. Maybe I'm missing something obvious in the methodology here, or were the datasets available to the two groups different? (or maybe the exclusions were done more rigourously by one group of researchers?)
    Agree completely with 11:56 that there is no benefit to RCGP or the UK (or anyone else or any other country of the world for that matter) if there are significant failings in the training programme for IMGs.

  • Evidence of racial bias in MRCGP exam claims author of independent review, as row erupts over 'contradictory' second version of research

    Ruth Lockley's comment 10 Oct 2013 10:02am

    I haven't commented for a while. I've been re-reading the report, watching Dr Esmail's video and following the threads on this in the BMJ as well as in Pulse, including the recent psychiatry one on BMJ
    Next part of judicial review is imminent, though I'm not clear if it's examining the evidence,or just about the GMC. It's ultimately now up to legal experts, with a far greater understanding of the intricacies and interpretations of discrimination law and its ethos to examine this. Hopefully this will be both educational and act as a stepping stone for all.
    I would like to comment back to 1/10 9:59 and 5/10 9pm personally, to explain that I constantly think through the effect this has on individuals. I was involved as a trainer (not RCGP) of many IMGs over the years and I've shared in their joys and sorrows. I'm similarly very familiar with how the training of med students and junior doctors has evolved over the last 10 years, and how important it is to recognise and address potential problems very early, not just before an exam, as seems to be happening based on posts here.
    My husband (non-medic) and I are both involved as volunteers in projects which involve numerous international (non-medical) graduates who are caught up in similarly difficult circumstances and are either out of work or working in jobs way below their qualification levels, or simple volunteering in related work to gain experience of culture and language, so this is a subject very close to my heart for reasons not relating to medical training too.
    I realise the decision to post anonymously or named is hard, but ultimately owning your own voice and having your own opinions is important. I could explain more from personal experience on that, but this is not the time or place.

  • Evidence of racial bias in MRCGP exam claims author of independent review, as row erupts over 'contradictory' second version of research

    Ruth Lockley's comment 01 Oct 2013 10:28pm

    anon at 8:53. I'm planning on re-reading it, because it's so complex that it deserves/needs it. But why do you make such a civil and polite request anonymously?
    I know some people are afraid that they may suffer discrimination as a result of posting with their name, but you really don't have anything to fear with that request, not from me or anyone else.

  • Evidence of racial bias in MRCGP exam claims author of independent review, as row erupts over 'contradictory' second version of research

    Ruth Lockley's comment 30 Sep 2013 11:13pm

    re 8:45pm the only thing I could read into the comments about 1st and subsequent attempts, was that the UK graduate BME candidates were judged to be finding it easier to know how to improve their performance the second time around than were the non-EEA and EEA BME candidates. I guess the presumption is that they have a better understanding of how clinical examinations tend to work in UK, and drew on that to help them. Perhaps their support network is also wider?
    I'm not sure how the investigators could have pinned it down any further than that, so those are just suggestions, not fact.
    Having read the report on the GMC website it seems to me that although there are things in the CSA that can be altered, the results at present are partly just reflecting what went before. Their figures seem to show that the likelihood of a pass or fail after following the CURRENT training route can almost be predicted for the candidates who've taken IELTS from their marks in this exam. Do candidates get told their IELTS result, is it ever discussed with them? And the AKT marks may give another, somewhat later, warning of trouble with the CSA.

    There's also a worrying suggestion that things will get worse as more foundation jobs start to include General Practice placements, giving those who've done foundation posts here an even bigger exposure to UK GP work, compared to those from the rest of the world.

    So is providing the same training to non-UK BME candidates and UK candidates actually indirect discrimination? (I don't know the answer, just trying to think it through) The report seems to give lots of ways in which the training might be modified to advance the skills of those who are apparently starting with a disadvantage. Do posters here think that these are viable proposals that would help? If I were still involved in training junior doctors and had a report like this in the specialty that I followed, I know what I would do, so I hope some actions are already in the pipeline/being implemented for you.

    I fully appreciate that this is not going to help the candidates who've already been lost to the system, after several years of hard work and good NHS service, which is a tragedy

    btw, there is one poster on these forums who does seem to feel that white female doctors, especially blonde ones, are the root of many problems. Since that is the least likely explanation of any that have been put forward, and also belittles females in general, I'd very politely and respectfully like to ask that poster to reconsider their wording. Thanks

  • Evidence of racial bias in MRCGP exam claims author of independent review, as row erupts over 'contradictory' second version of research

    Ruth Lockley's comment 29 Sep 2013 2:53pm

    1:35pm, I'd be interested to know where you produced those figures from? The only place I can see on a quick search that might add up to that is the BNP website, and they had very dubious reasons for using it.
    On the GMC figures
    http://www.gmc-uk.org/doctors/register/search_stats.asp
    there's a huge group for which no ethnicity is specified, so you'd have to have attributed a racial origin to at least 50,000 doctors before you could reach that conclusion from GMC figures..a fact the BNP conveniently ignore. ( I accept that not all GMC registered work in NHS)

  • Evidence of racial bias in MRCGP exam claims author of independent review, as row erupts over 'contradictory' second version of research

    Ruth Lockley's comment 27 Sep 2013 2:54pm

    Just read the BMJ article on line, and I think it's full of things to consider and discuss that have nothing to do with the apparent argument between Clare Gerada and the author.
    Once everyone has read it, hopefully there will be a good, in depth and helpful discussion of everything he says, from which college, deaneries, trainers, trainees and those considering coming to work in the NHS will all draw guidance and inspiration to find a way forward.

  • International doctors granted judicial review of the MRCGP exam

    Ruth Lockley's comment 16 Aug 2013 11:01am

    full text of 2010 US article above is at
    http://content.healthaffairs.org/content/29/8/1461.full

    thanks for all the other insightful comment of the last 24 hours

  • Extending GP access forms part of major NHS consultation on future of general practice

    Ruth Lockley's comment 15 Aug 2013 10:13am

    In communication terms NHS England have got a few lessons to learn! I've just tried wading through the slide set and the supporting information that goes with this. Maybe it's just me, but since when was it good practice to produce slides covered with dense writing, which looks like it's been lifted straight out of a publication?

    The graphs in the supporting evidence are confusing too. It looks to me as if sometimes white is "good" and dark blue is "bad" and sometimes the reverse. Pretty much sums up the current state of the NHS..

  • Extending GP access forms part of major NHS consultation on future of general practice

    Ruth Lockley's comment 15 Aug 2013 10:13am

    In communication terms NHS England have got a few lessons to learn! I've just tried wading through the slide set and the supporting information that goes with this. Maybe it's just me, but since when was it good practice to produce slides covered with dense writing, which looks like it's been lifted straight out of a publication?

    The graphs in the supporting evidence are confusing too. It looks to me as if sometimes white is "good" and dark blue is "bad" and sometimes the reverse. Pretty much sums up the current state of the NHS..

  • International doctors granted judicial review of the MRCGP exam

    Ruth Lockley's comment 12 Aug 2013 7:51pm

    thanks Una for all the extra info. Confidence, relaxation and return of the ability to behave naturally are definitely a major part of this. I have painful and expensive personal memories of exam failures from the early 1980s, which bear this out.(i did pass those and others later though) Also my gut feeling is that placements should be looked at to consider if extra access to white population patients can be arranged. I'm gald to hear that asian and black actors do make an appearance.

    I've been looking at a very interesting book on the internet, which goes into detail about the training of actors for these exams, and can see that it's extremely stressful for them too. I guess all of us know this from doing role play in our training and appreciate how real a role play feels and how differently you respond to different trainees and their manner of questioning/examing when you play the patient.
    Each encounter with a candidate is bound to be unique, and it wouldn't necessarily indicate a failure if a simulated patient fell silent, however off-putting that could be to someone who was in a panic. Obviously you can't read all of the book on line, but it's at
    http://books.google.co.uk/books?id=d4fVyXkgREwC&printsec=frontcover&source=gbs_ge_summary_r&cad=0#v=onepage&q&f=false if anyone wants to look.

    I suspect, as maybe you do, that the pass rate of white female doctors is a bit of a red herring. Medical education is not static, more and more UK med schools use actors extensively and female doctors have now far more female role models, support and confidence than even 5 to 10 years ago. Many have also made up their minds to pursue UK GP work very early in their training and so have a "head start". It may be a distraction to dwell on this when trying to get through the exam. Personally I'm very proud of how all UK female graduates of every race are now performing in medicine.(and proud of the guys too of course!)

    Anyway, I'm leaving this topic now as I don't think I can/should add more.

    Good luck to the candidates and hope some of them turn up in a practice near me soon!

  • International doctors granted judicial review of the MRCGP exam

    Ruth Lockley's comment 12 Aug 2013 12:01pm

    Anon at 0:38 has made salient points. Published UK figures on attainment at school, med school and post-grad non MRCGP exams find racial differences right through. Lots of exploration and action has not removed this. No recent studies have identified overt racism,so possibly factors acting from an early age are now involved in UK educated NW children. Because I've brought up my family in one of the most racially-mixed areas of the UK, where we are in a tiny white UK born minority, I've got a fair feel for this, over the last 30 years, from my childrens' friends, not just around the racial issues, but also around the religious and (to some extent) caste discrimination. I've been horrified how early in children's lives they start to express thoughts they can only have picked up at home, and I've huge admiration for our local primary and comprehensive school as to how they've tried to address and modify this, which also partially explains 0:38's comments about lack of bias; white children educated at our local school would similarly show little bias towards any racial group.
    But it still doesn't completely prepare you for going out into wholly white populations, which do still exist in large parts of the UK, and my entire (white) family actually feel pretty uncomfortable if we find ourselves in such situations, although we can hide this behind our whiteness.
    Which is why I'm amazed to read on this forumthat this is apparently such a "white" examination in actor and examiner terms. Is this true? NW UK educated graduates are going to be in a more familiar situation in this than overseas graduates, though still at some disadvantage, but if a major exit exam is going to take this format then I think that we should ensure that we recognise and reduce the potentially much greater disadvantage for non-UK grads within GP training.
    I'm sure this is happening to very good effect in some deaneries, but my experience of sexism (both overt and non-intended) in the UK education system and medical system over last 60 years would suggest that overseas graduates should try to maximise their exposure to the white UK population, both in their placements and in their life in the UK in order to beat the system they are presented with.
    Much better though if the exam actually reflected the racial profile of the UK.
    I realise the sensitivity of this topic, but it touches on points which are very close to my heart, so please see this as an attempt to genuinely explore this further, and apologies to people who've made major efforts to address this and feel that I may be judging them.

  • International doctors granted judicial review of the MRCGP exam

    Ruth Lockley's comment 10 Aug 2013 1:17pm

    I agree with the second part of the posting of anon at 9.38pm, although this is nothing new in NHS terms; because its all a bit more structured than it was in the 1970s and 1980s, it's more visible, but it's not new, and the structuring is getting more, not less, so we have to work with that in mind.
    But would bringing the equivalent of a CSA exam at entrance take away the requirement for doing one at exit too? Reading around this, the RCGP seem to have been singled out for praise in the past as to how they use this type of exam, compared to other Royal Colleges, in that they've applied more thought and rigour to its structure and assessment.
    BTW, realising that I'm as guilty as many on this thread at appearing to call this a test of communication skills, rather than clinical assessment, I've looked back at the RCGP reports linked above and, apart from the main feedback statement about management plans, the main areas in which feedback comments were made to RoW candidiates do seem to relate more to comms skills, rather than other competencies, especially the listening skills and use of cues.

    Looking at the literature on use of actors in medical education and examination, it seems that most evaluation has been done in undergraduate settings, but by and large actors come out with a very good record in examination conditions, especially in reducing variability in test conditions, so I'm not sure that real patients would improve the examination.
    From outside GP land this looks like a potential length of training and exposure to culture issue. There may well be discrimination involved in expecting doctors from outside UK to train to sit this exam with same training regime as UK graduates, in the same length of time, though some clearly succeed. There's no way of knowing from these reports whether that's down to good trainers recognising these potential pitfalls early, and putting in extra effort with their trainees to address this, or whether some trainees find the process of acquiring these skills more straightforward.

    I think it's vital that this is tested through the legal process, although this needs to be done as quickly as possible. I hope that we all come out the other end more enlightened and with more excellent and fulfilled doctors practising high quality primary care.

  • International doctors granted judicial review of the MRCGP exam

    Ruth Lockley's comment 09 Aug 2013 9:29pm

    in these detailed reports I'm struck by the difference in pass rate between deaneries, and between UK med schools. I'd like to know how much communication skills training is in each med school curriculum. At my local med school, where I volunteered as a mentor for many years, it was used from early in the course and involved with actors. Although mortifying for students (including white, middle class females) if they failed their first comms skills assessment, it gave them years to work on it, in order to graduate. This must be an advantage when sitting the CSA compared to candidates without such extensive exposure.
    It also appears to be true that whether you graduate in the UK or overseas, the skills needed to pass CSA appear to be more commonly possessed by females than by males, at least for their first attempt. This is even more striking in the difference in pass rates between non-UK male and non-UK female graduates Might this suggest that something in the UK medical school system, either pre or post-admission is selecting/training male candidates to get closer to the female level of skills assessed?
    I've been around too long and seen too much racism (and sexism) to ignore them out as an explanation of the results, but I'd also hate to see some really useful considerations ignored, which could have been of benefit to everyone

  • International doctors granted judicial review of the MRCGP exam

    Ruth Lockley's comment 09 Aug 2013 5:36pm

    two major questions which have struck me whilst reading these posts are:

    why are there apparently (according to posts) no/few non-white examiners?

    why are non-white actors apparently not used? There are certainly some very talented ones around, and to my mind they should make up 10-15% of the cases seen. Maybe there should also be the occasional station which involves communication through an interpreter?
    Addressing some small things in the interim wouldn't invalidate a larger enquiry into racism/sexism etc and these are two recommendations which might come out of that process anyway. But maybe these points have already been recognised and been acted on?

  • International doctors granted judicial review of the MRCGP exam

    Ruth Lockley's comment 09 Aug 2013 12:54pm

    our comments crossed in the post! It's good that you've provided the more recent stats.

    address to find them is
    http://www.rcgp.org.uk/gp-training-and-exams/mrcgp-exam-overview/mrcgp-annual-reports/~/media/Files/GP-training-and-exams/Annual%20reports/MRCGP%20Statistics%202011-12%20final%20121212.ashx

  • International doctors granted judicial review of the MRCGP exam

    Ruth Lockley's comment 09 Aug 2013 11:57am

    I was not a GP, but was involved as a trainer for many years in my own specialty before I retired, and have been following this discussion as I have a personal interest in understanding the outcome. In response to anon 5:07pm, there is a detailed report of the ethnic breakdown and country of graduation in this report
    http://www.rcgp.org.uk/gp-training-and-exams/mrcgp-exam-overview/~/media/Files/GP-training-and-exams/Annual%20reports/MRCGP%20Statistics%20201011%20draft%20at%20071111.ashx
    which is easy to find on the internet, although I can see it perhaps still does not go into the exact detail that anon 5:07pm may want.
    I've also looked at the US data which is often quoted on here and would say that it is similarly still a bit opaque, in that they appear to include in their count of "IMGs" those who are US citizens, possibly with families resident in US for several generations, but who have graduated from "off-shore" medical schools, which are often staffed (in my understanding) by visiting lecturers from mainland US med schools. We don't have anything like the same proportion of trainee doctors in this category as the US, so the term IMG has to be understood in the setting that it's used.
    I do hope that all the uncertainties around this are fully explored and explained soon; it's so important that the NHS is staffed with sufficient doctors giving good quality care that it's vital we acknowledge and remedy any deficiencies in training and examinations that stand in the way of this aim asap.

  • RCGP chair challenges Hunt for using GPs as 'scapegoat' over A&E failings

    Ruth Lockley's comment 26 Apr 2013 7:06pm

    Anon at 12.57, I don't think the actions taken in A/E are going completely unscrutinised. There's a huge amount of data available about them on the Health and Social Care information website, in "Accident and Emergency Attendances in England - 2010-11". Nearly 40% of attendees appear to have no investigations done (I realise that this will represent all patients , rather than just those seen in "majors"

    I totally agree that the A/E staff seeing them may have a lot less experience than their GP, and when I was one of those juniors (many moons ago) that also struck me as an anomaly. I was also frustrated by the potential need to "start from scratch" with each case because of the lack of previous records, which would have been available in primary care. With lab and radiology records now being visible on-line, that situation is eased somewhat, if previous investigations are visible on the hospital IT system, but it is still a huge duplication of effort and I'm sure it still sometimes takes at least as much, if not more time and resource to avoid an admission once an individual has got to A/E as it does to admit them.
    Whilst I would hate to see GPs taking back this workload and sinking under it again, I'm glad, as a patient, that it's being more openly debated, as I think that the current system neither provides good care nor represents good use of resources.

  • RCGP chair challenges Hunt for using GPs as 'scapegoat' over A&E failings

    Ruth Lockley's comment 26 Apr 2013 12:55pm

    When Mr Hunt is looking at a chart like this one http://www.nuffieldtrust.org.uk/data-and-charts/ae-attendances-england , it's easy to see why you could simplistically put the GP contract and the sudden apparent rise in A/E attendances together. If the suggestion is that this was due to a change in the way data was collected at that point, then that needs to be explained and examined.
    If pressure and money is to be taken out of secondary care, and re-invested in the community, it's inevitable that this always jumps out as a major target, even if it may not be the one of greatest benefit to patients.