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Independents' Day

Little improvement in international graduate scores on CSA, show new figures

The gap between the proportion of international medical graduates and UK graduates failing the RCGP membership exam has only slightly narrowed, results released by the college reveal.

The results, revealed in the MRCGP annual report, show that almost 60% of IMGs failed the clinical skills assessment between August 2012 and July 2013, compared with 7.5% of UK graduates.

The performance of IMGs showed only a marginal improvement on the 2011/12 intake, where 65.3% of IMGs failed, and this change was in line with a small improvement in results across the board.

The differences in failure rates between UK graduates and international medical graduates taking the exam has been the subject of a long-running row over the past year and is set to culminate in a judicial review hearing in April.

International doctor leaders said they were ‘disappointed’ that there was ‘no significant change’ in the results.

The results showed that 63.8% of IMGs from a black and minority ethnic background failed the exam, compared with only 3.5% of white UK graduates.

The scores for the advanced knowledge test (AKT) also showed significant differences in failure rates between IMGs and UK graduates, although not as stark, with 12.3% of UK graduates failing compared with 47.9% of IMGs.

UK graduated black and minority ethnic doctors’ scores improved - from a failure rate of 18.2% last year to 15.6% this year - but this was still way down on white UK graduated GPs’ results.

The judicial review into the differences in failure rates, instigated by the British Association of Physicians of Indian Origin and controversially backed by the BMA, is set to take place in April.

Dr Ramesh Mehta, the president of BAPIO, said: ‘We are disappointed that the story continues as before and there is no significant change. That clearly indicates that there has to be a change in the way assessment is carried out.’

‘We hope that once we have a positive result in the judicial review, we should be able to sit down with the college and look into a system of assessment that is fair and equitable.’

‘Patient safety and the quality of service remains of paramount importance to BAPIO.’

Dr Krishna Kasaraneni, chair of the GPC GP trainees subcommittee, said: ‘There still needs to be a lot of work to see why different groups and even medical schools have such different failure rates and this work needs to involve all stakeholders. The BMA would be happy to take part in that work.’

The MRCGP annual report also revealed that some candidates were allowed to retake the CSA exam because of ‘teething problems’ with the college’s new building.

It said: ‘Teething problems with the College’s new building meant that, because of unacceptable noise, some candidates sitting the November 2012 and May 2013 CSA were allowed an additional “non-counting” attempt subsequently.’


Proportion of graduates failing the CSA

International medical graduates59.80%65.30%59.20%
UK graduates7.50%9.90%8.20%
IMG (black and minority ethnic)63.80%68.10%62.10%
IMG (white)37.10%45.10%31.40%
UK (black and minority ethnic)15.60%18.20%16.10%
UK (white)3.50%5.80%3.90%




Readers' comments (37)

  • @7:46 different patient populations have different needs. Sometimes doctors may be requested to do things which are against good medical practice. If they refuse, a complaint may ensue. I hope your 'study' would include such factors. Do u assume that every complaint made against every doctor is legitimate ? Are you interested at all in the doctor's perspective?

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  • editor please can you keep this prominent on the website. the CSA is a very important issue and many people need to read this

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  • To 24 February 2014 6:07pm
    I am sorry, but you are ill informed, this scandal comes amid a furious row over the recent report of the Professor Aneez Esmail, a leading academic and GP, has accused the RCGP of "refusing to accept there is a problem" with the exam and trying to brush concerns about possible bias "under the carpet". His six-month review found that ethnic minority doctors trained in the UK were four times more likely to fail the exam at the first attempt than UK-trained white candidates, while ethnic minority doctors trained abroad were 14 times more likely to fail.

    In the GMC report, Professor Esmail and co-author Professor Chris Roberts say they cannot "confidently exclude bias from the examiners in the way that they assess non-white candidates.

    It is fundamentally wrong, that if a trainee cannot communicate as a snob, he or she is deemed to be unfit. You have to consider the fact that the majority fails by one mark, an obscured anomalies, they are not there to become surgeons but General Practitioners. CSA should involve real patients and not hired actors... etc... Equally, the culture of the old - boys network seems to be the ugly hidden factor behind this scandal. Have you ever heard that a Trainer or a Program Director of a Deanery being monitored for their competency level to train?
    Please check the facts before making judgement:

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  • @ Anonymous | 01 March 2014 11:14am

    You are lacking knowledge, and this is dangerous when you then proceed to express your opinions as fact.

    'In the GMC report, Professor Esmail and co-author Professor Chris Roberts say they cannot "confidently exclude bias from the examiners in the way that they assess non-white candidates.' - The fact they cannot confidently exclude bias, is not proof of bias in any form.

    ' Have you ever heard that a Trainer or a Program Director of a Deanery being monitored for their competency level to train? ' - Again a glaring error - as now all GP Trainers and all Program Directors are required to complete the Post Graduate Certificate in Education as an extra qualification to ensure high levels of teaching standards will be maintained.

    It is very sad that some trainees were accepted for GP training but are not able to pass the exams after multiple attempts - but a minimum standard needed to progress is required, otherwise why bother having any exit exams at all.

    If you are unable to communicate you will always struggle. Good candidates will always pass any exam.

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  • @1March 2014 2:04pm 'the Post Graduate Certificate in Education as an extra qualification to ensure high levels of teaching standards will be maintained.'
    slight problem with what you have said it has made virtually no difference for the pass rates of imgs and british ethnic minority doctors.
    Putting you head in the sand about issues that Aneez Ismail raised will not help either.
    You can continue the present approach of blaming the trainees but its not the trainees who developed the entrance exams into the VTS schemes nor did they devise this CSA 'exam.'
    An exam without real life patients, with an impossible appeals process and persistent refusal to have more than 1 examiner in each room unlike other exams.
    If you feel that despite this, this exam is fair then there is something greatly amiss?
    I am truly disturbed by the strange arguments people persist in employing to defend this CSA.
    If one is an img think very hard before going on the VTS scheme- it could be very painful. BAPIO must take measures to dissuade people from joining VTS schemes as it appears others do not care the slightest about img welfare

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  • BAPIO needs £200 000 in legal fees to fight their case in the courts. It is such a shame that one has to spend £200 000 to seek justice. You wonder if one has to spend that sort of mega money to seek justice for obvious injustice, what it says about the justice itself?

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  • @1049 2nd march 2014
    hit the nail on the head. it is a case of put up with injustice because one cannot afford the other form of justice i.e. a high court battle with huge amount of fees. if it weren't for bapio nobody would have that kind of money to engage in this essential fight for justice. you have seen the silly arguments people use to support the csa agenda. bapio still needs support

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  • Others might say that the silliest arguments were from BAPIO.

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  • @02 March 2014 9:21pm

    throughout this thread and others in pulse many have explained quite well why the csa is a poor exam.
    your post is a vital clue to the actual reason why bapio and poor imgs are having such a horrible time. Individuals such as yourself are not interested in the truth! You have already decided who you feel should pass and fail. so in many respects there is no point in having the exam is there?
    Can you give an example of an argument from Bapio which you think was silly and why?

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  • CSA assessment for clinical knowledge is appalling. While other Royal Colleges such as RCP is testing knowledge and clinical reasoning, CSA is testing counselling skills. We R DOCTORS!!! Not Social Workers!!! People can pass Myotonic Dystrophy in PACES but not able to pass Carpal Tunnel Syndrome in CSA. It's a joke!!! Even local medical student can pass CSA if he/she talks well...

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