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RCGP accused of discriminating against ethnic minority candidates in MRCGP legal case

The RCGP has come under fierce attack at the High Court by an association of Indian doctors who say that ethnic minorities are being discriminated against and disadvantaged in their attempts to enter the profession.

Pointing to the wide disparity between the results of British and non-white candidates in the college’s entry exams, the British Association of Physicians of Indian Origin (BAPIO) says its members are being subjected to bias and race discrimination.

BAPIO is asking top judge, Mr Justice Mitting, to find the college in breach of its duty under the Equality Act to ensure that all candidates sitting its membership (MRCGP) exams are treated the same - however, the College vehemently denies the accusations.

Karon Monaghan QC, for BAPIO, told the judge: ‘The issue arising in this claim is the marked differences in the MRCGP success rates as between international medical graduates (IMGs) and non-IMGs and different racial groups.’

Focusing on the clinical skills Assessment (CSA) component of the MRCGP, the barrister said: ‘The most recent figures show, for example, an overall first time pass rate for UK graduates in the CSA of 91.4%. The equivalent figure for IMGs was 39.6%.’

She added: ‘The figure for white UK graduates was 96.5% but for south Asian UK graduates it was 84.8%.’

Miss Monaghan argued that the college’s Equality Act duties required it to take proportionate ‘positive action’ to put right any disadvantage or discrimination being suffered by overseas doctors in the examinations process.

She told the judge: ‘The college has failed and is continuing to fail to comply with the Public Sector Equality Duty (PSED) in repeatedly applying the MRCGP and, in particular, the CSA without modification notwithstanding that the discriminatory, that is to say disparate, outcomes are clear.”

The College had conducted no equality impact assessment when the CSA was introduced in 2007 and had maintained the MRCGP as a requirement for membership notwithstanding its obviously disparate results, she added.

The QC added: ‘The College has, because of their ethnic origin, treated black and minority ethnic (BME) candidates - both British graduates and and IMGs - less favourably than it treats white candidates.’

Miss Monaghan said: ‘Overall, BAPIO contends that the candidates’ nationality, national or ethnic origin, or colour, has had a significant influence on the outcome of their examinations.’

‘The only proper inference, therefore, is that the college has directly discriminated against IMGs and BME candidates.’

In court documents, the college denies discrimination or breaching its Equality Act duties and, along with the GMC, is resisting BAPIO’s judicial review challenge.

BAPIO’s written evidence to the court reveals that the college says it has repeatedly reviewed its membership criteria, both internally and externally, and takes multiple steps to ensure that BMEs and IMGs are in no way disadvantaged.

Those include inviting external observers to view the CSA and positive support for trainers who are sent on advanced courses to ensure that the correct methodology is used.

The college says that the differential in exam results could result from a whole raft of factors, including the quality of undergraduate training in different countries; the overall quality of candidates and the time elapsed between qualifying and sitting the CSA, which tends to be higher for IMGs.

An RCGP spokesperson told Pulse: ‘As the Court hearing in relation to this issue is taking place this week, we do not believe it is appropriate to comment at this time.’

The hearing continues.

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Readers' comments (41)

  • Many things can be explained away with differences in terms of cultural understanding and training for doctors that qualified abroad. However, I would be interested to see if anyone has an explanation as to why there is a difference in rates for UK trained applicants.

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  • @5:55 - could it be that their parents are different language speakers.
    Could it be that they are more likely to speak more than one language.

    We live in a multicultural culture, and people born and raised within the UK can have very different upbringings. Could it be that their different culture means that they are less able to communicate with the majority patient.

    Then there are more tentative links. Those from more ethnically diverse families are more likely to be pushed harder at school. My Indian mother did a lot more pushing than my English father. This means that medical school entrants/ graduates from those backgrounds have often achieved that through hard work rather than an underlying intelligence and brightness, meaning that in a setting where they work equally as hard as an adult their results are less good.

    For the same reason their balance of achievement may be different between book smarts and communications smarts, meaning that their is a bigger disparity between international graduates AKT and CSA results.

    All the above may be right, may be wrong; but there are plenty of reasons to explain the differences - it will come down to who has the better lawyers to make their point.

    I would like to know why there is a difference between male and female achievement in English GCSE - are they all sexist - are the exams fair but education sexist?
    Do we need positive action for short basketball players, small rugby players etc?

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  • Tom Caldwell

    Most importantly when do they expect the result to be made public ?

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  • Vinci Ho

    Has come a long way but let's wait for Mr Mitting's verdict first .

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  • It is extremely sad that there is such a huge difference in pass rates. It is equally sad and frustrating that no concrete corrective steps have been taken and that the things had to come this far. It is very frustrating to see trainees and their families in distress as well as the loss of these trainees from general practice.
    Credibility of the system needs restoring and hopefully,the legal action will put a positive end to this fiasco.
    An IMG GP Trainer

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  • Whatever the outcome of this JR, the College's Officers, CEO and the Director responsible for education and examinations need to be held to account for bringing the profession and College into disrepute. This was not done in my name.

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  • I am not sure re ''quality of undergraduate training in different countries '' . I would agree that methods of undergraduate training are different. For example IMG undergraduate trainees see real patients with real symptoms in undergraduate medical exams instead of talking to actors.

    I am not sure re ' the time elapsed between qualifying and sitting the CSA, which tends to be higher for IMGs ', this would actually be a positive point. More experience in other specialities makes you a all rounded GP which is needed now as more secondary services are being moved into primary care. GP with previous experience in areas like diabetes would be an asset.

    I am not sure re ' quality of candidates '. They are all selected through the same recruitment process.

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  • re quality of undergraduate training:
    - there is still a sense of medicine being more academic in some countries and vocational here. I think that the UK system prepares better GPs (I suspect a more academic system prepares better professors of medicine etc).

    re elapsed time between qualifying and sitting the CSA. I am sure that makes a difference. People 'learn' to be lazier as time goes by. This is often being more efficient but does not fit with preparing for an exam. I think a degree of maturity (1 or 2 years between F2 and GP1 years) actually helps candidates but 6 years trying to get on a surgical program probably does not help.

    With regards to quality of candidates I agree that has a part to play. The selection centre is far less accurate / comprehensive as the combination of the CSA and AKT. It also assesses candidates overall rather than trying to separate academic and communication skills. When I did it there were only 2 communications skills assessments. All passing selection centre is far from saying all are good enough to complete training - otherwise there would be no need for any more exams ever.

    In fact you could extrapolate that getting into med school is enough to get through, getting through medschool is enough to get through specialty training and so on.

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  • I am appalled by some of the horrible pathetic arguments that continue to be used by supporters of the csa to defend this 'exam.' imgs/ British ethnic minority doctors should not apply to GP training until they receive an apology for this dreadful situation

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  • If all this leads to a simplification of the farcical process in obtaining the MRCGP, future General Practice, if it has a future, will benefit significantly.

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  • Bapio: No matter what happens, I respect you from the heart. We need organisations like you who is there for the weak and the fairness... Thank you Bapio!

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  • RCGP can bring flimsy explanations to defend their actions. They will continue to deny the candidates right to have an open and fair assessment process by denying to video or provide second examiner during the examination process. They can do all that but truth will prevail one day. It takes only person in the inner circle to spill the beans. Then we will know what really went in these organisations behind closed doors. It is a matter of time. We just have be patient. God is watching us.

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  • What utter drivel

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  • Fact - UK trained GP's better than foreign trained. FACT - government rubbing hands in glee as future RCGP exam will be some dumbed down easy to pass paper so GP's from anywhere can have the presently prestigious RCGP. FACT - GP pay will plummet. Well done all, another coffin in our already buried coffin. Disgraceful. I would like to respond to all those who will now say I'm a racist...... I am not, I can just see the dark future that awaits for our once great profession and the substandard care patients will get. Shameful....

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  • 'another nail' was what I meant!

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  • lets await the outcome of the review, personally i find the attitudes of so many of the complainants sickening and lacking any self insight- I just wonder if I would want any of them as my GP.

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  • the comments part of these stories does seem to rapidly descend into an unhelpful trade of barely disguised insult and rudeness. Such a shame.

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  • @ 7.14 - before the CSA and AKT there were no compulsory exams to practice as a GP, MRCGP was optional - did that affects GPs adversely ? did affect GP pay adversely ?. No one is arguing to ' dumb ' down MRCGP exam. Follow good practices done by others - recording, 2 examiners for each station etc. There are many ' foreign ' trained consultants, GPs across whole of UK - does that mean they are getting ' substandard ' care ??

    We need thousands more GPs in near future considering secondary care services moving to primary care and other changes, do we expect all local undergraduate trainees move to GP training ??, we also need IMG trainees. Rather than stating '' UK trained GP's better than foreign trained '', we need to look into how to best train IMGs in the 3 years training programme, look into CSA assessment, use 2 examiners, video recording etc

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  • Who ever wins the case, what is the RCGP going to do to regain the confidence of all GPs? It needs to do what it recommends to all its trainees. Reflection on all aspects of the way it works by a group that is independent, respected and not part of the present or recent past leadership.

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  • @9.18 - undergraduate training is different from postgraduate training. In undergraduate training one needs to go through '' academic '' subjects like anatomy, microbiology, pathology, physiology etc to understand medicine and prepare for future postgraduate training. Otherwise without the basic medical sciences which are '' academic '' we would be producing hollow doctors. Would pts prefer to see a doctor with poor understanding of '' academic '' basic medical sciences and just good in communication skills ??
    Med school training is different from postgraduate training and cannot be extrapolated.

    In the US more emphasis is given on the rigorous postgraduate training than exams. Once you get through the initial screening USMLE and complete the training programme, the board exams towards the end are optional and one can still practice in that particular speciality without the boards. Thats the confidence they have in their training and not just relying on exams towards the end.

    And the AKT, CSA exams started recently, before that GPs could still practice without MRCGP. Were they not better GPs ??

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