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Porter: RCGP must 'acknowledge there is a problem' in exam row

Exclusive BMA chair Dr Mark Porter has criticised the RCGP’s response to the independent review into potential racial bias in the MRCGP exam, claiming that the college ‘must be brought to realise’ it has to address the controversy.

Speaking at a dinner event at the annual conference of the British International Doctors’ Association in Burnley over the weekend, Dr Porter said the RCGP’s response to the findings of the review by racism expert Professor Aneez Esmail was ‘not good enough’, and it was ‘stunning’ that such a ‘respected author’ could not exclude the possibility of subjective bias.

Dr Porter’s comments mark the strongest criticism yet from the BMA over the controversy, after an independent review of the MRCGP by Professor Esmail found ‘significant differences’ in failure rates between different ethnic groups in the CSA exam.

Professor Esmail’s full report - commissioned by the GMC - concluded ‘the method of assessment is not a reason for the differential outcomes that we have described’, leading the RCGP and the GMC to claim that it had exonerated the clinical skills assessment.

But a separate paper by Professor Esmail - published in the BMJ at the same time as his report to the GMC, and based on the same research - concluded that that ‘subjective bias due to racial discrimination’ in the CSA may be a cause of higher failure rates for UK-born ethnic minority and international candidates taking the exam.

A furious row then erupted as Professor Esmail warned that evidence of racial bias must not be swept ‘under the carpet’ and accused the GMC of misrepresenting his research - a claim the GMC strenuously rejected.

The RCGP, which is currently facing a judicial review brought by international doctors seeking to declare the exam unlawful, has consistently denied that the exam is in any way discriminatory or biased.

Dr Porter told doctors at the BIDA conference dinner that the BMA would push for meetings with the RCGP to ‘get to a place where they acknowledge there is a problem’.

He said that both the GMC-commissioned review and the BMJ paper had ‘the same authors, the same data and pretty much the same conclusions if you read them’.

‘Though it is possible to hide behind the different use of language to say one exonerates the RCGP while the other condemns it, I am not sure either goes to that end,’ he said. ‘The point is, there is an issue there to be dealt with.’

Dr Porter said the BMA’s own study over the past six months had made recommendations ‘around ensuring the CSA includes a diverse mix of cases, that examiners are drawn from a diverse population, and that candidates should receive more feedback’.

He added: ‘We’ve drawn this up before finding out that Professor Esmail was making similar recommendations, which is good because his recommendations are based on solid and objective data whereas ours were based on a discursive examination of what was happening around the various royal colleges.’

Dr Porter said: ‘One of the reasons the RCGP finds itself in the firing line is because they have such good data that people can look through them and find statistically valid data for analysis, which cannot be said of all royal colleges.’

But he added: ‘Essentially, we have said what we are doing and what BAPIO are doing, but we have a royal college here that must be brought to realise what the problem is.’

‘Significant questions remain unanswered and putting out a press release last week that basically says “there is no case to answer here, move on and don’t look at us and we’ll get on with defending the Judicial Review” – that is not good enough.’

Dr Porter referred to a previous speaker’s mention of the fiftieth anniversary of Martin Luther King’s ‘I have a dream’ speech, and ‘tremendous changes that have taken place in some ways but not others’.

He added: ‘It is stunning that we can get to 2013 and find that a major royal college is running examinations from which a respected author can conclude that we cannot exclude the issue of subjective bias.’

The BMA would meet with the RCGP to discuss the issue, Dr Porter said: ‘We are trying to help the RCGP to get to a place where they can acknowledge there is a problem and have something done about it rather than saying “we have been exonerated” and we will be taking that forward in the next week.’

In a separate statement released yesterday, the BMA announced that Dr Porter met Professor Esmail last week.

Dr Chandra Kanneganti, a member of BIDA’s executive committee and a member of the GPC, said: ‘I’m happy that Dr Porter spoke about these issues. He also spoke about other issues affecting international medical graduates and we would like to thank him for highlighting these issues more than ever before.’

A statement from the RCGP said: ‘It is our job to ensure that, through a fair process, all the doctors who qualify as GPs meet the requisite standards for ensuring safe patient care. That is what the public expects of us, and that is what we deliver.

‘We take equality and diversity issues extremely seriously and we already take comprehensive steps to ensure that the exam is fair and equitable to all candidatesand are currently reviewing the recommendations in this area from Professor Esmail’s independent GMC-commissioned review of the MRCGP.

‘We have been well aware of differential pass rates for many years, as is the case with all medical specialties, and have worked very hard to understand the possible reasons for the differences. We are currently in contact about this matter with the BMA, the deaneries and the Academy of Medical Royal Colleges.’

‘We are extremely surprised that while Professor Esmail’s official GMC investigation found no evidence of discrimination in the RCGP exam, there are now media reports suggesting that the exam may be discriminatory after all.’

‘In the official and independent GMC report, Professor Esmail found that “the method of [the RCGP] examination is not a reason for the differential outcomes that…have been described. The CSA examination is based on a well established pedagogy which is internationally recognised and used widely in postgraduate examinations”.’

“He also said that: ‘Our observations suggest that international medical graduates are treated exactly the same as British graduates’, going on to say: ‘Lack of preparedness’ of international medical graduates ‘may be an explanation for the differences between the two groups’.

The High Court will next week hear an appeal by the British Association of Physicians of Indian Origin (BAPIO) against a decision to exclude the GMC from its judicial review on the CSA. The hearing will also announce the date of the full judicial review.


This was updated at 16:14 on Wednesday 9 October

Readers' comments (40)

  • @1:47
    Thanks for your kind words.
    I have considered Australia and New zealand but it will take some time for me to get my confidence back.
    I'm sure once you become a trainer, you will do a much better job than some of the present trainers who have no clue about this exam.

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  • Times have changed. When I was an undergraduate and we had examinations on which promotion depended, most of the students who failed were convinced one or other of the examiners 'had it in for them'. There was never any appeal process, and no one ever complained about this. No one went through our examination papers to tell us in what areas we were deficient; and the only check on bias was the presence of an external examiner, who we all thought was there to ensure that our professors were not too lenient..

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  • I agree with Adrian.
    Good old days. Examiners did their job well. No one had to question their judgement because almost every candidate felt it was fair. Only a fair few failed and there were valid reasons for that. Statistics for MRCGP is staggering. There is something really fishy about this exam. RCGP attitude and resistance for video the exam is astonishing and almost a sign of accepting the guilt. Good luck chaps.

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  • The BMA & GMC have been silent and therefore complicit for far too long. The RCGP should never have been allowed to assume responsibility for the licensing exam. They are only interested in milking trainees to pay for the unnecessary new HQ in Euston.

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  • This comment has been moderated

  • Do people really think the examiners are racists? Get real!

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  • anonymous@ 6:20
    How do you know they are not?
    Most of the posters here have suffered at the hands of these CSA examiners and role players and hence know for sure there is some element of direct discrimination. It seems you have not got any sympathy for those who have suffered due to this exam and are defending the RCGP as if you are one of them!!

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  • I am astonished at what Dr Porter says. I will be leaving the BMA (after 34 years)in protest. He clearly has only read the headline and not the evidence.

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  • Anonymous @ 620, if you think there is no racial bias in the CSA exam then you should read the BMJ article more carefully. Bias is a very difficult concept and no doubt we are all guilty of succumbing to it in one way or another. The problem here is the fact that the bias in the RCGP exam leaves some candidates, from a specific and well defined group, disadvantaged. Having gone through exactly the same process at every stage as their peers, they are then left out at the last minute with no qualification or career in front of them. That can not be right.
    As for Adrian Pointer's comment, times really have changed. The sooner the RCGP understands this, the better it is.

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  • I agree with Alok. This is a dirty game between GMC, RCGP, deaneries, trainee practices and the affected trainees where everyone is trying to blame the other but no one seems to do anything. The only agency which has stood up for the trainees is BAPIO with BPDF, BIDA, BMA providing some outside support.
    These agencies should help BAPIO to fight against RCGP for this noble cause.

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  • @Alok Tyagi, You say, 'Having gone through exactly the same process at every stage as their peers'. That is an incorrect statement and flawed assumption. IMGs complete the majority of their medical education overseas, where general practice may not even exist as a discipline. It's not even something they grew up with. For some, foundation and specialty training is their first exposure to GP. That's not racism. It's fact.

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