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BMA calls for review of postgraduate GP training to address alleged racial bias

The whole of postgraduate GP education should be reviewed for international medical graduates, with training tailored to ‘individual needs’, the chair of the BMA GP trainees subcommittee has said.

Dr Krishna Kasaraneni said one curriculum was not enough and that ‘the whole process has to be looked at, not just the end measure’, but said he acknowledged constraints on funding would make this difficult to achieve.

Dr Kasaraneni was speaking at a session on training at the RCGP annual conference in Harrogate last week. It comes after a row erupted over a review of the MRCGP exam by academic Professor Aneez Esmail, who refuted RCGP and GMC claims his report had exonerated the exam of any racial bias.

RCGP chair Professor Clare Gerada said in her final annual conference address that she was sorry that the allegations of bias were causing distress, but that the college completely rejected the claims.

She said: ‘I am very sorry these allegations are causing so much distress. But as an organisation that takes equality and diversity very seriously, the College refutes the claims – totally. And last week I was pleased to see the College was vindicated by an official GMC report that found “the method of assessment is not a reason for the differential outcomes”.’

Speaking later at the session on training, Professor Gerada added: ‘We have unbelievable faith in the IMGs, my father was one of them. But we cannot expect to have an exam where just because you’re sitting it you de facto pass it.’

But the Dr Kasaraneni insisted questions over the differential pass rates for international and UK medical graduates from non-white groupsneeded to be answered. He said: ‘If someone is failing at the end of three years, the whole process has to be looked at not just the end measure. The problem isn’t simply about where somebody’s trained and then they’ve come here. IMGs don’t just land at Heathrow and come in and take the CSA.’

He added: ‘Professor Esmail [in his report] published last week specifically said the problems IMGs face compared with UK graduates are very, very different. Language plays a role – but there’s also issues regarding primary care in that person’s country of origin.’

But Dr Helen Stokes-Lampard, RCGP honorary treasurer, defended the College’s position. She said: ‘We have to look at it from the patients’ point of view – call it the “Daily Mail” test. They want doctors who have passed exams, they want doctors who have been given the qualifications for doing the time in training, they want them to have proven they are of a standard to be good at the most difficult job in medicine, which is being a good generalist.

‘The differential pass rate is something we all regret – it’s not ideal and we will try to address what we can. But the reality is we’ve got to defend our patients – I’m not getting a plane with a pilot who isn’t qualified to fly that plane.’

Readers' comments (10)

  • With respect, simply that the College refutes claims of bias does not mean it does not exist. We need to consider the evidence. The College clearly cannot be objective in this and should allow independent review without exerting its influence or using the press for its own ends. Isn't this, in a sense, a form of perverting the course of justice?

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  • "Daily Mail" test. When did Daily Mail become RCGP standard!
    Some (in)famous Daily Mail headings
    "Abortion hope after 'gay genes' finding" DM 1993
    "How Race Militants Hijacked a Tragedy" 1993
    Jan Moir article on the death of Stephen Gately, which many people felt was inaccurate, insensitive, and homophobic. 2009
    So RCGP standards are based on a newspaper which is commonly perceived as being racist, homophobic, anti-semitic and anti-poor.

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  • Unfortunately its the blind men and the elephant story all over again. The college will refute that racial bias exists even if the courts decides in favor of IMGs.
    Does Dr Helen Lampard check the credentials of all the pilots...she must be put on the next flight to Timbuktu!! To say that you are not of the standard after failing a flawed exam is not a good argument.

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  • Give the Daily Mail readers what they want?! - our heads on a plate if some of their online comments are any indication...

    Anyway pilots fall asleep during the flight. A licence doesn't prevent it. In any case our IMG's are licensed doctors. They are also qualified, experienced and safe doctors who have passed all other aspects of the training programme and have already been competently working as GP's.

    Will you stop all none MRCGP GPs from practising??

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  • Communication does have some intercultural variations and this may be a possible factor. My concern about making any individual allowances is where does it stop and what happens in the real world. If an individual GP irrespective of background, gender, race etc communicates less effectively than another, do you allow him/her more time or select the patients etc or what because that would not seem equitable.

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  • I heard a leading undercover media program investigating the consultation skills of the practicing GPs including CSA examiners/major players in medical education. It would be interesting to see whether they practice what they preach.

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  • @ Dr Helen Stokes-Lampard
    It's kinda funny that you compared the whole scenario with flying and being a pilot. Let me point out to you in your own terms. IMGs all passed the REAL time flying sessions but failed the Simulation. God!!! I really hate educating these naive folks...

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  • Munna Bhai MBBS

    These reports are not doing any good to the morale of IMG's appearing for AKT/CSA in the near future. Why is that RCGP is the centre of racial bias allegations and not any other Royal college?
    Clare and Helen stokes-Lampard's comments will lead us no where. I agreee with Dr Esmail's study and the others who feel that the bias is too obvious to be ignored.
    Let me give you a very small example-
    In this exam you could easily fail any candidate by giving him/her 0/3 in interpersonal skills as there are no set parameters that would decide these 3 marks. So a particular examiner can give me 0/3, 1/3, 2/3 or 3/3 for doing practically the same thing depending on his subjective understanding of my interpersonal skills. This is exactly why IMG's are failing so much.
    As the RCGP ladies above have defended the exam by saying there can't be any exam to pass everyone, I would simply argue -there can't be any exam to fail everyone simply because the examiners can decide that subjectively on a case to case basis!!

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  • I have seen nobody coming out with a realistic model for changing the exam, just complaining that they are being hard done by.

    Videos where you present your best case, can demonstrate that you are providing consultations to the appropriate standard 1/100 times, but could be terrible 99/100 in the videos that are not submitted. My understanding from my predecessors is that passing the video assessment was more about videoing numbers and being good at reviewing them rather than being good at consultations per se.

    WPAs like COTs are very good formatively, but even more subjective than the CSA and examined by someone who has an interest in giving a pass rather than fail. There is also the personal relationship bias where you are less likely to pass if your trainer dislikes you or perhaps is racist.

    I think the best outcome is that people who fail (or perhaps everyone) should be given their videos with detailed commentary of their errors. However I think it is unfair to charge more to those who sail through the assessment, so it should be an option that is funded individually. To pay an examiner to do this will be really expensive.

    Even if the uptake is low, the examiner knowing he has to justify his decision to pass or fail a candidate can only lead to a fairer exam.

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  • IMG and BME candidates are at a loss of 39 marks from the minute they enter exam room. Most of them fail by 1 or 2 marks. This is where the racial bias is. Is that clear ladies?

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