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International doctors advised they have 'strong legal case' against RCGP exam

Exclusive: The Indian doctors’ representative body has been advised it has a ‘strong legal case’ for action against the RCGP over the high failure rate of international medical graduates taking the College’s exit exam.

Dr Ramesh Mehta, the chair of the British Association of Physicians of Indian Origin, told Pulse it will continue to prioritise ongoing discussions ith the College, but it has received legal advice that supported a possible judicial review application.

BAPIO has begun collecting funds for a possible legal action and held an emergency meeting on Saturday to discuss the failure rates of IMGs taking the clinical skill assessment (CSA) component of the MRCGP.

The development came as RCGP chair Clare Gerada sent an email to members over the weekend saying the College is taking matters ‘very seriously’.

‘The issue about the exam and the high failure rate of overseas graduates is something that continues to raise its head and it’s really important that you know where the College stands,’ she wrote.

‘While we might not be ‘out there’ contributing to the noise as much as some of you might prefer, we take such matters very seriously. This is a very sensitive issue and a lot of work is being done behind the scenes.

‘The College is the standard setter for our profession. We exist to improve patient care and to that end, we must ensure that our assessments are as robust and rigorous as possible and that the trainees going through the process are the very best that they can be.’

She said there had been ‘noise’ on Pulse and Twitter about the issue.

She added: ‘It’s unfortunate that people can hide behind anonymity or choose to air their grievances in public, knowing that the College will never break confidentiality or fight its battles through the media.’

Dr Gerada added that the failure rates for the Applied Knowledge Test, which is anonymised and marked electronically, showed similar patterns to the CSA.

‘I hope we are now in constructive dialogue for moving forward. There will be another meeting in the New Year, to which we have also invited COGPED, and I will keep you posted,’ she said.

Dr Mehta said the weekend’s conference was an ‘emotional meeting’ with around 40 people attending.

He added: ‘Our trainees feel angry and demoralised about the way the assessment is carried out. We have received initial advice from our legal team. The advice is we have a strong case against the fairness of the assessment. That was encouraging for the trainees and they decided to start collecting funds.’

‘However, the BAPIO Executive said it will continue to collect funds but it would rather continue dialogue with RCGP. We will try our best to find a negotiated settlement.’

Readers' comments (147)

  • 3:57 pm: valid points.

    How would you complaint about training?
    To whom?
    What would happen if you complain?
    How will things change for the betterment?
    Current training is flawed?
    Are trainers aware that they are incompetent?
    Do deaneries know that they are not fit for purpose?

    Come on. Enough of pillar to post game. Complete overhaul of this very subjective, indirectly discriminative exam is required.

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  • My reason for contributing to this forum, as a trainer who had many IMG's , all of whom passed the CSA, is like many others I am on your side but am concerned that these accusations about the college's motives and values and threats of legal action will divide you from the very people whose support and help could be very helpful to trainees who are finding the CSA a block to their careers and humbly suggest a more collaborative approach may be more successful.

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  • I can relate to the concerns of the trainees whose lives have been wrecked over this issue. I see years of bottled up frustration comes out from many whom denied justice. I also do share your right for freedom of expression.
    BUT WE MUST NOT LOOSE FOCUS FRIENDS!! WE MUST TRY TO ADDRESS THE INJUSTICE AS FACTS AND WITH WHAT EVER THE EVIDENCES AT OUR DISPOSAL TO GET THROUGH OUR MESSAGE WITH OUT TARGETING CERTAIN NAMED INDIVIDUALS WITHIN THE LEADERSHIP.
    THE LEADERSHIP HAS A COLLECTIVE RESPONSIBILITY TOWARDS ALL ITS MEMBERS AND LETS BE FOCUSED AND STICK TO THE POINT. Otherwise I am worried our concerns might not appeal to many who might want to listen to us. Its only my opinion. Hope it makes sense.
    LWT

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  • @22 December 2012 4:17pm
    Dear Sir,
    Thanks for your comments. May I ask how do you " suggest a more collaborative approach" which you feel MAY be more successful? May I also ask what has not been done to discuss this issue before the legal action was planned?
    Please be clear as to what do you think needs to be done?
    Thanks

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  • Yes - 4:17 pm:

    What exactly needs to be done??

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  • @4,17...see clara gerada's response, plus pressure on deaneries who select people as being 'trainable' who then do not pass to address the issues why a significant number do not make it- have their educational needs been understood and addressed? the problem does seem to be worse with some deaneries who have huge intakes with a higher proportion of img's who probably scored poorly on their entry exam who don't have the educational resources to support their trainees sufficiently

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  • STERIOTYPING OF IMGs NEEDS TO CHANGE WITHIN OUR PROFESSION !!!
    I SINCERELY HOPE THE RCGP LEADERSHIP, EXAMINERS, EDUCATORS AND TRAINEES WILL READ THIS ARTICLE AND REFLECT ON THIS STUDY.
    Among us, clever few might get ideas how to get the best potential out of the IMGs without demoralising them.
    ...
    SENSE OF INJUSTICE IS A POWERFUL DETERENT TO THE PROGRESS OF ANY SORT!!!
    At the end only the British economy and the British public would be the beneficiary of such a vision.

    http://www.ncbi.nlm.nih.gov/pubmed/20679648

    Health Aff (Millwood). 2010 Aug;29(8):1461-8. doi: 10.1377/hlthaff.2009.0222.
    Evaluating the quality of care provided by graduates of international medical schools.
    Norcini JJ, Boulet JR, Dauphinee WD, Opalek A, Krantz ID, Anderson ST.
    Source
    Foundation for Advancement of International Medical Education and Research, in Philadelphia, Pennsylvania, USA. jnorcini@FAIMER.org
    Abstract
    One-quarter of practicing physicians in the United States are graduates of international medical schools. The quality of care provided by doctors educated abroad has been the subject of ongoing concern. Our analysis of 244,153 hospitalizations in Pennsylvania found that patients of doctors who graduated from international medical schools and were not U.S. citizens at the time they entered medical school had significantly lower mortality rates than patients cared for by doctors who graduated from U.S. medical schools or who were U.S. citizens and received their degrees abroad. The patient population consisted of those with congestive heart failure or acute myocardial infarction. We found no significant mortality difference when comparing all international medical graduates with all U.S. medical school graduates.

    LWT

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  • This comment has been moderated

  • So are BAPIO also going to challenge the GMC where IMGs have a disproportionately higher level of serious complaints and poor /mal practice? It is well recognised that both language skills and attitude (latter may be cultural) are major contributors to this problem. If you wish to be a successful GP in the UK you need to have the language skills and accept the established UK cultural norms ( ie where there is negotiation with patients and exploration of their ideas/concerns/ expectations etc). I suspect many of the MRCGP failures lack these skills

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  • I encourage everyone here to please contact their MPs to raise the issue in Parliament. The way trainees, especially IMGs have been treated is terrible. My heart goes out to those who lost their final sitting this November. Waiting for bapio to mount a legal challenge is an option or you can be more proactive - peaceful demonstrations and get in touch with your MP. Let's get our story told and out there in the media.

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  • I do not know the merits of the specific issue but would make two general points.
    1) Every loosing party in a court case has a lawyer who advised them " you have a strong case" so the only certain winner is the legal profession.
    2) an examination based on knowledge of the prevalance of and consensus management of illness in a geographical location is likely to favour those who trained or have practiced extensively in that location.
    I suspect my personal deficiency in the knowledge of the management of venomous snake/lizard and spider bite may mean I do rather poorly in an Australian higher professional exam.

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