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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)

  • Anonymous@ 7.29AM
    I failed CSA 4times. I still think that your comment is not fair. There is clear and huge difference between Carpal Tunnel Syndrome or Myotonic dystrophy in terms of pathology and a patient with CTS/MD. I know the difference, but under pressure , I automatically switch to your mentality and fail

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  • It would be interesting to see which examiners mark down the IMGs consistently. If such examiners are found, their examining skills need to be compared with rest of the examiners who do not demonstrate such tendency. It is only fair such examiners to be excluded from the examiners pool and make them accountable for the trainees they have failed unfairly.

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  • Based on my experience , CSA exam is not a good exam to differentiate good and poor candidates.Its sensitivity and specificity appears to be very low. So many bad candidates slip through the net.

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  • The saga of CSA is never ending story unless some realistic and fruitful steps taken by RCGP to correct bias, deaneries to train the trainers properly and catch struggling candidates early in the training with more input to improve their communication skills. It is a misfortune to blame the IMGs, when they have achieved to get a training post and rubbish them at the end of the training saying they are useless. Everyone talks about communication, but without actual 'COMMUNICATION'. Is there a study comparing examiners performance wrt to IMGs and local graduates and their pass rates! It would be interesting to know the facts, if they have one!!

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  • I just sat my CSA exam. I concur with @10:28. In our deanery, east kent, we have had those who have slipped through the net. If I was a patient i would never go to these so called RCGP approved " future" GPs. They are plain rubbish but don't know how they've managed to clear CSA. Probably being an empathetic actor, they've "shone".
    Common fact that NHS is failing esp GP Land being hit the hardest. I have no hope in this new crop from my deanery ( not certain of you all ). Govt restrictions, patient demands, target issues can only worsen this much loved job.
    you may call me a pessimist but that's also the reality. Sugar coating the fact will not hide the truth.

    - Tj Ans

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  • Recently I have heard regarding a IMG doctor working in paediatrics as a staff grade for couple of years after passing his exams applied for CCT, went through the whole training and has now been appointed as a consultant in paediatrics and is now helping to improve local nephrology services.

    Could we imagine anything similar and accomodating with RCGP. Its a shame that good quality trainees only because they cannot be 100 % on the CSA day have left with no hope of practising as a GP again after training for 3 years ! their would be valuable contribution to General Practise is lost forever !

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  • The CSA is a ridiculous test. I sat it in December 2014 and I do not feel it relates to everyday general practice. The only facet it 'actually' tests is your ability to communicate. I grant this is, quite obviously, an important quality in any Doctor, but then to look beyond the AKT, PSQs, CbDs, COTs, mini CEXs, MSFs and clinical and educational supervision reports and judge the CSA as the definitive parameter by which a trainee is deemed competent is ludicrous - especially when such trainees have practiced successfully for years as competent GMC accredited Doctors.

    The RCGP is digging it's own hole for the future of general practice in this country.

    I hope I pass my CSA but being a British born Asian, I cannot be so sure.

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