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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)

  • I came to UK in 1978 and at every job I was asked when am I going back to my country-I continued and when the time came in 1990s to get a training year for General Practice the same scenario appeared that because I spent 12 years as anaesthetist I was branded as rusty but then there was some one who recognised my talent in North Wales and gave me the break-I have never looked back-since then I got the certificate--trained as a GPwSI diabetes -participated in many trials and became a clinical lead having done a very successful fund holding carrier-after retirement I am still working for a CCG as the clinical lead and tutor--so the policy of discrimination has never changed --even as anaesthetist I was always given the difficult tasks which gave me a buzz--and the very people who thought I was rusty were asking for advice when they were stuck with a complicated case of diabetes--so the college rather than wasting so much money should own up to the discriminatory attitude and move forwards and let people give to the society the many skills the so called failed candidates have-just use the commonsense

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  • It is not possible to predict with certainty the outcome of a judicial review Though innocent with caveats,must be the odds on favourite
    All these young doctors passed the academically validated selection process and the similarly validated long cumbersome beauracratic work placed based assesment process
    Since all these assesments purport to indicate suitability to do the same thing i.e. consult in gneral practice the massive discrepency in their findings is astonishing
    So where does the racism occur, in the passing of the first two assesments when the candidate is given false hope, or in the third assesment when hope is extinguished
    I t is possible to predict with certainty that the verdict will not end the controversy

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  • IMG & BME Drs are doing WELL in AKT(Computer Based) and poor in CSA ( face-face based)

    It proves there is a Biased at the CSA.

    Biased occurs while Looking at the Drs ( His/Her colour, accent & verbal and nonverbal communications- by the Examiners(RCGP) and the Actors(Who are substituting-the Real patients) at the CSA.

    It can be improved, modified & the biased removed by Replacing the CSA from the Face to Face to the Computer Based Examinations as been done in many countries including USA which will be fair to the all concern.

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  • I am a UK born and trained GP of Indian/Pakistani origin. I passed every exam for the MRCGP first time and easily. I know IMGs and BME doctors that will watch films in their mother tongue - they will speak to me in their mother tongue, they will have a large cultural influence from their parental culture on their viewpoint and outlook. This is undoubtedly going to reduce their chances of passing an exam that is almost entirely based on British problems and in a British cultural context. What may be more appropriate is CSA exam that incorporates a reflective percentage of ethnically, culturally and even linguistically diverse scenarios, such as to match the current UK demographics.......but that's easy for me to say now that I've done my exams!

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  • Dr Mustapha Tahir

    What buffles me about this case is, why has any of the Royal Colleges never had to face this allegation? Or did I miss on the current affairs? Please let someone explain to me.

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  • @ 12.52 - '' cultural influence from their parental culture will undoubtedly going to reduce their chances of passing an exam '' - what utter nonsense ! is this exam testing parental cultural infuences ???, it seems like you are not very comfortable being spoken to in ' your mother tongue ' ?? and appears like being ashamed of watching films in ' your mother tongue '.

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  • I honestly couldn't care less that the non UK born IMGs are faring badly compared to their British counterparts because that can be easily explained away by language,cultural and educational differences.What is of more concern and something that hasn't been adequately explained is the presence of a significant gap between UK born white and UK born non-white graduates.I have yet to meet a single UK born non white graduate whose first language was not english.In fact quite a few of them,like their white counterparts, have been to public school.So using language in this case as an excuse doesn't wash.Assuming that these statistics are valid and not just a false positive there is a system bias somewhere.

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  • @ 1:09, its because the way training is structured. not passing the exams means the end of GP career while in other specialities one can still practice without the exams - as clinical fellow, staff grade, associate specialist etc.

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  • @ 1.13 '' I honestly couldn't care less that the non UK born IMGs are faring badly compared to their British counterparts because that can be easily explained away by language,cultural and educational differences ''

    ok but such a huge huge difference !!, then why is this not the same in US where there are as many IMGs as here ??

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  • @1:11. Your quote of my 12:52 comment is incorrect - taken out of context and doesn't even read correctly. I said ".....they will have a large cultural influence from their parental culture on their viewpoint and outlook. This is undoubtedly going to reduce their chances of passing an exam that is almost entirely based on British problems and in a British cultural context. ". Of course it is! Read 12:52 again - The influence of culture, language and religion plays a massive part in normal human interaction. General Practice is not just about the medicine is it. If you think it is just about the medicine then you are deluded and merely perpetuating incorrect advice given to the BME doctors.

    I also suggested that the default language for many of them is their mother tongue. Of course this will impact their ability to communicate where the default language is English. Paralinguistic cues, phrases, even saying things in a certain way confer different meanings. If you are used to doing that in Punjabi or Hindi then you will miss things when someone communicates using English - again please don't tell the IMGs/BMEs that its OK to just speak whatever language they want because that shouldn't affect your ability to communicate with the British people - that's utter rubbish.

    Also I am fluent - 100% fluent in Punjabi and Hindi/Urdu. I can read and write in my mother tongue to very good standard. I can mix culturally with Indian people absolutely fine - and I am not ashamed of my mother tongue or culture - but I am not willing to demand special dispensation for it when I live and work in Britain - an English speaking country with British values.

    Finally I think it appropriate to include a mix of problems and languages in the CSA - after all a white doctor is quite likely to need to speak to Punjabi/Urdu/Hindi/Polish speaking patient. The mix should reflect the current percentages of those languages in the UK - that will the exam more reflective of the British population not changing it so that British culture and the English language becomes irrelevant - because it's not!

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