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RCGP threatened with court action again over BME bias

Exclusive The international doctor’s group that took the RCGP to court over the MRCGP exam in 2013 is ‘strongly considering’ legal action against the College again, Pulse has learned.

The British Association of Physicians of Indian Origin (BAPIO) has said it has been in regular discussion with the RCGP since the verdict found the clinical skills assessment (CSA) was lawful, despite the differential attainment in the pass rate between white and non-white medical graduates.

Yet BAPIO has said that the RCGP has not been following through with any of the suggestions made during these discussions and that the only way forward now is to ‘go for another judicial review.’

The RCGP said the meetings with BAPIO have been 'constructive' so it was 'disappointing' that BAPIO are speaking out in this manner. 

In 2014, the judge found the CSA exam was lawful but Mr Justice Mitting said in his judgement that if the RCGP does not act, it is subject to a further challenge.

BAPIO president Dr Ramesh Mehta said there is no point continuing talks if the RCGP doesn’t accept BAPIO’s advice.

He said: ‘Soon after the verdict, RCGP invited us for a talk to see what can be done and since then we’ve been talking on a regular basis with RCGP. The RCGP has said (and they keep on saying) that CSA is not an issue. The issue is with the training and they say, "we want to maintain the quality". However, we are not happy at all with this, because we have suggested a few things and they haven’t followed through.

‘What they’re doing is a tick box. What’s the point of talking to us if you don’t change anything, if you don’t accept our advice? The only way forward now, we are very strongly considering whether we should take Mr Justice Mitting's advice and go for another judicial review. It’s a nightmare.’

The RCGP has issued a statement, saying that it is 'disappointing' that BAPIO has chosen to speak out in this manner.

RCGP chair Professor Helen Stokes-Lampard said: 'It is disappointing that BAPIO have chosen to air their opinions in this way as our meetings with them – as well as with other stakeholders and experts in the field of licensing examinations - have been constructive in our opinion, and have helped shape the steps we are taking to ensure the MRCGP continues to be a fair and robust assessment, as the independent review found it was, and to address the root causes of differential attainment issues in medical education and training.'

Last year, the RCGP published its independent 10-year review of the MRCGP, which concluded the exam was ‘fit for purpose and fair’ to all candidates and patients.

Professor Stokes-Lampard added in response that the MRCGP exam has ‘no characteristics’ that would cause differential attainment.

She said: ‘The recent independent review of the MRCGP assessment, commissioned by the College, found that the CSA and AKT were fit for purpose and fair for both candidates and patients. It found no characteristics of the exam design or administration procedures that would cause differential pass rates, but it did make recommendations in the spirit of continuous quality improvement.

‘Work on two such initiatives - reviewing the ethnic diversity of CSA cases, and taking steps to ensure the examiners panel was inclusive and representative - is underway and progress will be reported on further in our MRCGP annual report later this year.’

Following the review, the RCGP added that it has developed resources and events to support trainers and trainees in CSA preparation and also introduced an exceptional fifth attempt of the CSA or AKT exam.

In 2017, a Pulse analysis of CSA pass rates found the gap between white and black and minority ethnic doctors was the widest ever recorded.

According to the RCGP's latest annual report from 2017/18, the pass rate of the AKT exam for white doctors was 86.8% and 60.7% for all BME doctors. For the CSA exam, 93.8% of white graduates passed, compared with 83.4% of UK-educated BME graduates and 39% of internationally-educated BME graduates.

Professor Aneez Esmail from the University of Manchester, who wrote a GMC-commissioner report on the fairness of the MRCGP, said the changes are just ‘cosmetic’.

He said: ‘These changes are simply cosmetic and certainly won’t make any impact (as the recent data shows). They have been saying the same thing for many years now and you would have thought that despite trying to do something and realising nothing has changed that they would try a different tack.

‘I remain sceptical as to how committed they are to change. They will say that there is no evidence of discrimination and are in effect are putting their heads in the sand, ignoring the facts and hoping that something will change but probably more importantly that no one will complain too much.’

But there are efforts elsewhere to help international doctors pass the MRCGP exam. Health Education England has stated it has some initiatives to guide international doctors.

HEE's deputy medical director of primary care, Professor Simon Gregory, said: ‘The focus is on providing a re-entry route for those who were progressing in training but were unable to pass just one of the exam components of the MRCGP qualification in the time available. We don’t want to end up losing trainees simply because they needed a little bit of extra time on one of the components of training.’

Readers' comments (26)

  • It’s not just about ‘throwing racism up in the air’, it’s about the social and professional appreciation of personal diversity and all that it entails I.e also including social class, gender and psychological differences (it’s well known that there is a high incidence of ‘Spectrum’ in the medical profession and most can appreciate the benefits this brings to management of complex issues). Pompous, ageing, white, neurotypical Professor Sirs, have done enormous damage to primary care, both through their activity and non-activity.
    Well it’s an opinion to explain the present shambles.

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  • The job needs doing by people capable of passing the CSA. You don’t alter the demands of the job to keep applicants happy, you set a standard that needs to be met, no excuses.

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  • No excuses indeed needed for standards. But that’s not the matter under consideration. It’s that the assessment process is discriminatory and unfit/unfair for purpose. It simply doesn’t measure what it claims to. Ask BAPIO. Want to predict the outcome if this goes back to court?

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  • Tom Caldwell

    Is there any information on what suggestions BAPIO made that we’re not followed up?

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  • Consider the makeup of the csa examiner panel, I feel that this is the problem with a bias against examiners of differing backgrounds and locations throughout the uk, I don’t know of any ANY current csa examiners from Northern Ireland general practice.....I don’t know the ethnicity breakdown of the examiners but it would be an interesting question to ask.....

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  • What do you guys think about the fact that Physician Associates(PAs) allowed to run their own patient lists and qualified doctors who went through medical school, GP training and failed one component of MRCGP by a couple of maks in a subjective exam thrown out after three years of GP training labelling them as unsafe/incompetent doctors to work in General Practice? Are we truly worried about patient safety? I wonder how many practices with CSA examiners employ PAs in their practices as a cost-cutting measure. RCGP comes up with interesting explanations to justify whatever they do. I am intrigued to know about their position regarding recruiting PAs to work as GPs.Surely they will not fail to surprise me with a gift-wrapped flimsy explanation which will be in line with their agenda.

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  • "Health Education England has stated it has SOME initiatives to guide international doctors." From past experiences I think we can safely assume that when HEE says SOME they mean NONE.

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  • "reviewing the ethnic diversity of CSA cases, and taking steps to ensure the examiners panel was inclusive and representative"
    BEING A BAME MYSELF I CAN SPEAK FROM EXPERIENCE THAT THE MOST RACIST PEOPLE I HAVE MET TOWARDS MYSELF COME FROM THE (SADLY)BAME ITSELF. When they sucessfully reach a certain position/level they feel they have suddenly metamorphed into whites( with their colour, accent and all).

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  • @ Decorumest- So examiners are racistly downmarking certain groups despite them performing as well as other candidates. That indeed needs investigation.

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  • I have seen trainee practitioners managing patients on their own.They havent gone through any of the rigorous training we as doctors have to go through. Many a times the patient comes to see you after seeing the trainee practitioner and tells you that they didnt have a clue what they were dealing with?This is RCGP standard.

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