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Independents' Day

BMA to meet with authors of MRCGP review to discuss findings

The BMA said ‘significant questions’ still remain unanswered on whether subjective bias is a factor in the marking of the clinical skills assessment, following the final publication of the GMC-commissioned review of the MRCGP exam.

Dr Krishna Kasaraneni, chair of the BMA GP Trainees Subcommittee said the BMA would meet the authors to discuss the issue of subjective bias and broader issues around the lower pass rates of graduates from certain groups.

Dr Kasaraneni welcomed the report’s recommendations around including a diverse mix of cases, drawing examiners from a wide demographic pool and giving candidates more detailed feedback.

He also called for further research into what happens to trainees forced to withdraw from training, whether the Annual Review of Competence Progression which assesses progress is fair and asked deaneries to research variations in pass rates.

Currently the RCGP is facing a judicial review brought by international doctors who want the exam declared unlawful, and has sparked a row after it called a version of the research conducted by an independent expert into the pass rates ‘misleading’.

Dr Kasaraneni said: ‘Significant questions still remain unanswered though, especially around not being able to exclude subjective bias in the marking of the CSA.’

‘As such, BMA representatives will meet the authors to discuss this and other issues raised in the report and consideration will given to the broader issue of the relative performance of trainees in examinations across the Royal Colleges.’

The final version of the GMC review was published yesterday, but another version of the research published by the BMJ made slightly differently worded conclusions, saying that ‘subjective bias due to racial discrimination’ in the clinical skills assessment may be a cause of higher failure rates for UK-born ethnic minority and international candidates taking the exam, a stance the RCGP strongly rejects.

But the author of the report, Professor Aneez Esmail, an expert in racism in the NHS, has accused the GMC and RCGP of misrepresenting his report’s findings and said evidence of racial bias must not be swept ‘under the carpet’.

Dr Ramesh Mehta, president of the British Association of Physicians of Indian Origin (BAPIO) - the organisation bringing the judical review - said it ‘welcomes and is relieved’ by the findings in the BMJ paper.

He added: ‘It will not be wise to ignore Esmails’ and Roberts’ concerns when they say “We cannot ascertain if the standardised patients (played by actors) behave differently in front of candidates from non-white ethnic groups. Nor can we confidently exclude bias from the examiners in the way that they assess non-white candidates”. It is very difficult to have confidence in an examination under these circumstances.’

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  • Krishna Kasaraneni

Readers' comments (5)

  • evidence of racial bias must not be swept ‘under the carpet’.
    Hell yes! It is a bad thing. Don't do it again please.

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  • Sudheer Surapaneni

    #institutionaldiscriminationnhs continues daily at every sphere. BMA has to address this more strongly than at present to win back the trust of the BME doctors(at least 30-40% in the NHS)

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  • I have appeared for CSA three times each time failed by 1 mark. After my 2nd failure I worked very hard. I practiced lots of consultations and was seeing 40 + patients every day. At times I was the only Dr available and patients and practice staff were very impressed by my PHQ score was 4.8/5 above UK average.i diagnosed numerous conditions like bowel and lung ca, type 1 DM & coeliac, P.E,HSV encephalitis, depression.PCP pneumonia in HIV and many more & felt proud to have saved lives. In my 3rd attempt at CSA the actor gave me wrong findings and was corrected by the examiner in the real exam!!! Also in telephone consultation the sound quality was very poor. Unfortunately I failed by 1 mark. I raised the above issues in my exam with the RCGP who sent me a letter stating that they cannot do anything now but are happy to give me an additional chance at the exam if my deanery supports my application. Well the deanery unfortunately refused to support the application and now I am kicked out of training . I was at home for 3 months without job and now Fy2 locum in A & E. I am currently also taking antidepressants and trying to salvage my relationship from falling apart. I have spent about 20,000 pounds for CSA . (This includes 8 CSA courses with the college).
    I think I did everything I could to pass this exam. I feel the exam lacks objectivity and depends on role players and actors. Why don't they use some real patients?? The actors mistake ruined my life/ my career.
    I have gone to practice since been out of gp training too embarrassed . Staff and patients will be shocked that I can never work as a gp for them I was the best. Can anyone advice me regarding my career development ?? I am 42 years old.thank you and god bless you all ram

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  • Dr Gerada, in her interview this morning on BBC said that CSA is a "cultural exam"!!! which is contrary to the scoring sheet - as the marks are given for being able to gather info ex: patients reason for attendance/ideas to the nature of their complaint/ concerns/expectations/ and requirement to develop rapport/ to arrive at a joint management plan. Although there is a standard consultation model, which we are encouraged to follow- we are also encouraged to make it our own..
    Surely this is not a "cultural awareness exam" or did I train on a different planet? Missed it altogether.

    If it is a" cultural exam" then I wonder why the pass rate is not equal for British born/trained ethnic minority to white british! Although practices at home may vary, exposure in communal area/ education would presumably be same…hmmm thats food for thought.

    I welcome the judicial review..which is long awaited and reflects on institutional discrimination. If "comprehensive steps have been taken to ensure the exam is equitable and fair to all candidates" I don't understand the persistent difference in pass rates!!!!

    I am sure we will hear all about it in the near future!

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