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A faulty production line

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)

  • It looks like BMA has realised RCGP is going to lose the cause....

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  • Edoardo Cervoni

    RCGP (and BMA) may have to reconsider their mission, vision and strategy.
    At the present, my humble opinion is that they lack of a clear scope and that I cannot see many colleagues around passionate about their memberships.
    When being a MRCGP or a FRCGP is seen as being “financially” advantageous or a “must”, there is something wrong. The only thing I would advocate in the medical field are passion and dedication. The nearest you are to the pity “cash”, the worse it gets (pretty much everything).
    As far as the exams are concerned, I would suggest to "breaking down" the assessments during the training years.
    Furthermore, after many years of clinical practice, I can confidently say that non-clinical skills and values are grossly under-estimated.

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  • @09 October 2013 8:40pm
    “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.”
    How would you account for the astonishing discrepancy of the pass rate between “white British” and “BME British” candidates. Surely you will have another FLIMSY EXPLANATION like the above to defend the latter. GET REAL BUDDY!!

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  • The real issue is that doctors should be safe to practice and be able to communicate with their patients.

    Sadly many doctors are not safe to practice, nothing to do with their medical skills but the fact that we are told over 900 of them have criminal offences

    Re communication, many foreign doctors speak English, but not in a clear enough manner that we can understand them. Many foreign doctors have have very strong accents and speak far to fast fro us to keep up with their ramblings.

    I would also agree that there are some fantastic foreign doctors from all around the world. It does leave me wondering what happens to the born and bread English doctors that are becoming a rare breed?

    Everyone wants the best of care from the best doctors so please let us make sure any doctor working in Britain is nothing but the best in their field!

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  • @shurleea Harding,
    I agree that every one deserve best treatment. I am IMG with postgraduate qualification not only from Britain but Overseas.
    I have worked in different seniority levels in UK. I have seen every complication and practice written in the books and some not written in UK and people responsible are both "BEST BRITISH" doctors and Bad IMGs.
    I was never asked by any gp in saw in UK like I am expected to ask?
    Get real. British Medicine is not best, perhaps it is run by IMGs.
    UK is only country with F1, F2, Speciality Doc, Staff Grade, SPR, StR, Associate specialist, subconsultant, clinical assistants. so much discrimination in same grade.

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  • Shurlee Harding :
    These doctors with "strong accents" and who "speak fast and rambles" are deemed fit to practice by the GMC by way of PLAB. Which is Professional and Linguistic assessment board exam. Their "accents" and "rambles" are assessed thoroughly in the linguistic component.
    So might I suggest you write to the GMC and raise your concerns about the PLAB exam as to why it has allowed those doctors "with strong rambling accents" fit to practice.

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  • Dear Shurleea harding
    please kindly learn to write English properly. Lot of fundamental mistakes in your comments.

    Many foreign doctors HAVE HAVE very strong accents and speak far TO fast FRO us to keep up with their ramblings.(it is TOO fast FOR)
    born and bread English (it is BRED not BREAD!)


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