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International doctors call on RCGP to follow physicians' lead on exit exams

An international doctors’ association has called for the RCGP to use the Royal College of Physician’s exam as a template to prevent it developing a ‘bad reputation’.

The chair of the British Association of Physicians of Indian Origin (BAPIO), Dr Ramesh Mehta, said that talks were ongoing with the RCP on reducing the differentials between the pass rates of UK graduates and international medical graduates (IMGs) and praised the college for reviewing the issue, which resulted in the college throwing out an examiner who was found to be racially biased.

He called on all royal colleges to follow the RCP’s use of two examiners and real patients for its version of the clinical skills assessment.

Speaking to Pulse at BAPIO’s annual conference, Dr Mehta said the organisation had been in discussions with the director of the MRCP exams, Professor Jane Dacre, and the two parties are discussing the results of the MRCP exam.

Dr Mehta said that the RCP’s acceptance that there is an issue surrounding differing pass-rates between IMGs and local graduates is ‘a start’ that paves way for finding a ‘reasonable’ solution. He said: ‘We will have a roundtable with them [RCP] to sort out the problem and if we can sort out this one that will set an example for other colleges to follow.’

He welcomed the RCP’s use of two examiners and real patients. The RCGP assessment uses a single examiner and actors instead of patients.

BAPIO is currently undertaking legal action against the RCGP and the GMC over the differentials in the rates of UK graduates and IMGs passing its clinical skills assessment, which will result in a judicial review, likely to take place in February.

This followed a study in the BMJ that found that there could be an element of racial bias in the CSA exam. However, the RCGP said that a GMC-commissioned report similtaneously published by the same author, Professor Aneez Esmail, cleared the exam of racial bias, leading to a row between the college and Professor Esmail.

Dr Mehta Pulse: ‘I have no doubt that the approach to the RCGP examination is deeply flawed and there is a problem especially for IMGS. Whether the problem is training itself or whether there is subjective bias – I have a feeling both of these are important.

‘There is an unease amongst the profession that this sort of discussion about alleged inequality and racism among the RCGP may lead to bad reputation of the college. However I believe that we will find the solution and once we find it – the college will be in a much better position and will be much more respectable.’

Speaking at the conference, Professor Dacre said that although a study of the MCRP exam has proved it is clear of racial bias, ‘that was a single study and the results of that were very much about our exam and cannot be generalised to the rest of the profession where I think things may appear to be different.’

A former examiner had been discharged following an investigation, admitted the MRCP lead.

She said: ‘We have done some work looking to see whether there was evidence of sex or race bias. Our two examiners in one station have allowed us to do that statistically. We had one examiner who was found to be racially biased. That person is no longer an examiner.’

Dr Dacre told the conference that this method had helped solve the issue of gaps between IMGs and UK graduates pass rates.

The RCP says that the pass-rate gap between IMGs and UK trainees in the MRCP, taken by 24,000 candidates worldwide, is caused by its international reach. With centres opening internationally to allow candidates to take exams overseas the gap has widened and could be related to training rather than bias. Professor Dacre said: ‘Prior to that the gap between IMGs and UK graduates was diminishing.’

She insisted that ‘trainees are the jewel in the crown of the NHS’, and that ‘it is not acceptable for a competent doctor to fail the assessment if the assessment is unfair.’

During her presentation, Professor Dacre highlighted the issue of funding postgraduate examinations and that online systems are planned to alleviate costs to candidates.

Readers' comments (26)

  • Some trainers feel that there is nothing wrong and that there is no need for an extra examiner. in fact they think there is no issue with the csa. maybe we need to turn the spotlight onto the trainers......

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  • Had my CSA this weeks- one of the actor was looking quiet bored & was just saying the lines & not acting- showed no response when I gave possible bad news & when asked told she was shocked when she didnt look shocked-. Another candidate mentioned actor was giggling & then said sorry it wasn't a part of the role. How am I supposed to show empathy etc etc when the actors aren't giving their best?

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  • Close down the RCGP and let the RCP administer the licensing exams. They have several hundred years' experience and clearly know what they are doing.

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  • @10:13 Couldn't agree more. The RCGP leadership is a bunch of amateurs, whose main concern is raising their personal profile and rubbing shoulders with politicians. They do not give a damn about the grassroots and certainly not patients. I vote for a credible body like the RCP to restore the integrity of our training and accreditation.

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  • I too agree with the last two comments.

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  • @9:31
    My last case was about genetics, the actress was tired and fed up, she said just explain to me how it is transmitted and what is my risk, she did not like me to do any more hx or ICE ...etc. she took the examiner and left around the 7th minute looking very satisfied with my performance, the result was several crosses on things that I did not cover.

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  • trainees are the jewel in the crown of the NHS’, and that ‘it is not acceptable for a competent doctor to fail the assessment if the assessment is unfair.’ Prof. Dacre -RCP
    I have done both the CSA and MRCP. MRCP is a decent and fair exam. In my opinion CSA is not up to the job. CSA is mostly about touchy feely. It is all about acting rather than clinical competency. Why I say this?
    GPs must possess very good history taking and examination skills as they have limited availability for tests/scans/on site specialist advice and so forth. If the GP do not have a very good ability to pick up clinical symptoms and signs using his senses the patient will be paying the price. MRCP exam assess the latter with elegance. Although CSA stands for “Clinical Skills Assessment” it does not assess the ability to make rational clinical decisions based on EXPLORED CLINICAL SYMPTOMS OR ELICITED CLINICAL SIGNS ON REAL PATIENTS!!
    Who do we consult in real life? ACTORS without real illnesses OR PATIENTS WITH REAL ILLNESSES?

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  • Dr Dacre was brave to accept there was a hawk among the examiner in front of international doctors . Look at the state of rcgp .The entire training is toxic . I have to credit to my trainer her eyes showed to me that she was unconvinced about the exam. She never openly admitted the exam had a problem .My programme directors are totally different I am tired of discussing about this issue . I feel we need to wait for the judge to come a decision . I agree with all the comment mentioned above

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  • The truth is that THE CSA IS A FLAWED EXAM. End of. Forget all the fancy studies and analysis and listen to people who have done this 'exam'. Whether the RCGP will ever accept this is a different story. God help the IMG!

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