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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)

  • @ 1:11, I think you need to read Prof Esmail's CSA review in BMJ to get your view points clarified. The very huge difference in pass rates could not be just attributed to cultural and saying things in a certain way context.

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  • @ 2:08 - '' 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 ''
    - does this imply - that IMGs should be advised to stop speaking their ' mother tongue ' or ' whatever language' so as to communicate here ???. This usually comes from a confused person who is not sure about his / her origins.

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  • There is no solidarity in this profession. Qualified members have idly stood by and paid their annual dues of £500+ to perpetuate the squalid regime and defend the indefensible. If BAPIO's case is upheld will the old guard continue to support a disreputable body? I left 10 years ago and have saved over £5,000 in todays money. My practice goes from strength to strength and I am free to choose whatever CPD support I require. There is no point in the RCGP.

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  • @ 1:111, An IMG or for that matter any person is perfectly capable of remaining connected to his / her cultural roots, speak their ' mother tongue ' and watch films in ' mother tongue ' and still be able to effectively communicate here. I agree some language nuances could play a role affecting a IMGs perfomance, but such glaringly huge difference in passrates needs another explanation.

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  • I passed my RCGP in second attempt. I am happy to be IMG, multilingual and have experience in different specialities. This is British exam and focuses on communication skills which is very important for GPS who are point of first contact for majority of the patients. Most of British graduates do well in this exam as they get lots of teaching on communication skills in their medical schools. IMGs should focus on their weaknesses during training. Emphasis should be on better training for IMGs rather than blaming college for being racist. I feel this exam does prepare you better for General practice. Again it's easy for me to say that as I have passed.

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  • Too many people are firing off an opinion here without any knowledge of the facts. Forget the CSA if you like -- what about the AKT? That is a machine marked test (blind to the ethnicity of the candidate) and the first attempt failure rates are 4.4% for white UK trained graduates and 65.2% for BME IMGs (nearly all Indian and Pakistani trained). Doesn't this suggest that many of these candidates, coming from a culture that has an imperfectly developed social health GP service, are not properly prepared for flying solo as a GP in the UK. We must stick to solid evidence. It is the safety of patients that we risk if we do not.

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  • I have seen numerus colleagues failing the exams, getting extensions into the training and than eventually passing it. I have never seen any Doctor being removed from the training due to constant failures.

    This just makes me feel the colleagues who have actually been out of traning despite several attempts and extensions in their training, were they really meant to be GPs?

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  • Please note I am not doubting those colleagues's ability as Doctors.....but this si not quite the same as GPs.

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  • Well, speaking as someone who recently sat (and passed) the CSA, i can genuinely say in think its a fair exam, I know i would have said that even if i failed. There was nothing in the exam which i would regard as unfair. Being a GP is about a lot more than clinical knowledge on its own. Perhpas the people who complain about the "racism" in the exam should spend some more time concentrating on their weaknesses and addressing these to pass rather than just moaning about it being "unfair" or blaming the colour of their skin. If i went to India or France or anywhere else to practice, i would exopect to have to adjust my styke and communication skills to suit the environment i was working in.

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  • The problem with the overseas drs argument is that the results in the face to face exams are very similar to the results for the machine marked AKT exam. This would suggest that the large disparity between the pass rates is not due to overt racism, but may be due to other factors such as lanquage.

    Where there is more of a problem is in the UK educated asian drs. There is a reasonably slim difference which may be due to racial bias on behalf of either the examiners or the actors, or equally it may be due to other factors (such as mentioned earlier with Indian parents being very successful at making their children owrk at school) - one just cannot tell. The ;problem with a face to face exam is that the suspicion of bias will always be there.

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