This site is intended for health professionals only

At the heart of general practice since 1960

Read the latest issue online

CAMHS won't see you now

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)

  • If the international graduates were as good as the UK graduates they wouldn't fail. Having been a 'patient' in the MRCP PACES exam last autumn I can testify that the international graduates in that particular exam were abyssmal - most of them were international too. It wasn't to do with language or colour, it was simply that they didn't know their stuff well enough. Bit shocking too to think they those particular candidates were already practicing doctors !

    Unsuitable or offensive? Report this comment

  • So how do you account for a 3 fold difference in UK white vsUK qualified BME candidates?

    That is a huge discrepancy, and since these are trainees who have trained in the UK, demonstrates that there clearly is a racial bias against BME candidates.

    DOI a white UK GP from the old MRCGP system, which was far better than this crap is.

    Unsuitable or offensive? Report this comment

  • "So how do you account for a 3 fold difference in UK white vs UK qualified BME candidates? "

    That is the question!

    Unsuitable or offensive? Report this comment

  • Una Coales

    According to this latest CSA report, as a non UK medical school graduate of Korean ethnicity, I have a 0% chance of passing CSA and a white UK medical school graduate has a 96.5% chance of passing the same CSA. That in itself, suggests this exam may need tweaking?

    I agree with @6:41; in my opinion, the old MRCGP exam was far superior.

    Unsuitable or offensive? Report this comment

  • its so sad to see the overt injustice against imgs carrying on in plain sight

    Unsuitable or offensive? Report this comment

  • This comment has been deleted by the moderator

    Unsuitable or offensive? Report this comment

  • Perhaps it is not racism, but simply a question of language. This is simply intended to stimulate debate.

    UK born White candidates usually are born into an English speaking household, and speak English for their entire life, so you would expect them to be fluent in communication in their native tongue.

    UK born BME doctors may well have been born into a household where English is not a first language, and their parents may not speak fluent English, though they will learn it from an early age. The majority will be as fluent as their colleagues, but due to cultural differences, their language skills will also be developed in their native language also, and there may be some whose home life is spent communicating in another language, and regional/cultural language may also have an impact during the formative years.

    If you were to look back and study GCSE English results and compare back to the exam results at CSA - would there be a correlation with those results, and those passing with grade lower than an 'A' being more likely to fail the CSA? This may explain the differences between the British born cohorts.

    As international graduates will not have English as a first language in the majority of cases, and although they may have even studied in English, the nuances of communicating in English, to English populations may not be a skill they would excel in compared to a British born candidate.

    I have met many excellent IMGs - but even when looking at the best ones, they often have poorer English language skills compared to their British born peers, but that is not unexpected. If you compare their GCSE equivalent skills it may correlate with their chances of passing, as would the number of years spent in the UK prior to starting training.

    It must be a disadvantage to any candidate to take an exam based so heavily in communication, when it is not your first language, and it is only really spoken at work. The rest of the time is often spent communicating in their native tongue with friends and family, and entertainment is often in native languages also.

    This problem will remain with the CSA while it is so heavily testing communication skills - however as a GP you will be needing those skills each and every day.

    Poor communication skills do need to be weeded out ideally prior to starting GP training at the selection centre stage. This will prevent good doctors wasting years training when they have a limited chance of actually passing the exit exam to become a GP.

    Unsuitable or offensive? Report this comment

  • Out of interest do you get similar results at undergraduate level?

    Unsuitable or offensive? Report this comment

  • Munna Bhai MBBS

    Story continues....
    Racism vs non racism
    People are comparing MRCP paces with Csa. Are they suggesting that in their opinion the 3 years GP training is a wasteful exercise? MRCP can be done without any training but CSA is done after 3 years training at par with white graduates. At the end of 3 years training, why do such differences exist and why has the college and the deaneries done nothing about it?
    If it were the case of white UK graduates would these bodies have kept quiet?
    When CSA was introduced, a few white candidates were affected and the RCGP refunded the whole fee and gave a free attempt in which all those failed candidates managed to pass. Is it not discrimination?

    Unsuitable or offensive? Report this comment

  • @8:26am
    Please check the pass rates in USA/Canda
    For your knowledge their first language is 'English'!

    Unsuitable or offensive? Report this comment

View results 10 results per page20 results per page50 results per page

Have your say