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A faulty production line

RCGP exam results reveal narrowing gaps between UK and overseas graduates

The gap between white UK graduates and other graduates taking the RCGP’s exit exam is narrowing, the latest figures have revealed, following a lengthy legal battle.

The latest MRCGP annual report shows that the overall number of non-UK medical graduates who failed the clinical skills assessment (CSA) fell by nine percentage points – from 60% to 51% – from 2012/13 to 2013/14, and from 65% in 2011/12.

However, the proportion of non-white UK graduates failing the exam stayed the same.

The BMA welcomed the figures, but said there was still ‘a lot of work to do’.

This follows the long-running row about the differences in failure rates between UK graduates and international medical graduates, which sparked a judicial review hearing instigated by the British Association of Physicians of Indian Origin (BAPIO) in April last year.

The review ruled that the exam was lawful but the judge stressed that the RCGP needed to ‘eliminate discrimination’ in the MRCGP and tackle the differences in failure rates between white and non-white medical graduates sitting the CSA.

Following the court case, the RCGP welcomed the judge’s ruling and agreed ‘further action is needed’ to support medical graduates who fail the CSA.

The college decided to put the diversity and membership across all its main areas of work under the microscope, including the MRCGP examinations and the recruitment of clinical leads, committee members and staff, and set up two groups to review its policies.

The latest figures also revealed that the failure rates of non-UK educated South Asians - which has traditionally been the group with the highest failure rates - fell from 64% in 2012/13 to 55% in 2013/14.

The number of black UK graduates who failed the exam dropped from 28% in 2012/13 to 20% in 2013/14, although the numbers involved were very small.

Dr Maureen Baker, chair of the RCGP, said: ‘The overall pass rate across all elements of the MRCGP assessment has increased between 2012-13 to 2013-14.

‘The key purpose of the exam is to ensure that all GPs who pass are fit and confident to practise independently and provide excellent and safe care for their patients. This increase means that there are more doctors, in the community doing this, which is good news.

‘The RCGP has long-recognised differential pass rates for IMGs and BME UK graduates taking the exam for the first time, which is the norm in professional and higher education examinations, but we are working with BAPIO, the British International Doctors Association, and other stakeholders to address this.’

Dr Krishna Kasaraneni, the chair of the BMA equality and inclusion committee and the GPC’s training and education subcommittee, said: ‘This is an encouraging step forward and follows on from concerted action taken by the BMA to address this issue. We have worked tirelessly with the Royal Colleges, GMC and medical education and training organisations to address differential attainment.

‘We recently brought together key stakeholders in this field to identify and prioritise a number of critical interventions that are likely to make a difference.  We still have a lot of work to do and we will continue to work collaboratively to ensure that the process is fair for all doctors.’

Failure rates of selected groups


 Non white UK graduatesSouth Asian non-UK graduatesOverall non-UK graduatesWhite UK graduates
2013-14(112) 15.3%(216) 54.80%(322) 50.80%(75) 4.90%
2012-13(104) 15.6%(333) 63.70%(489) 59.80%(48) 3.50%
2011-12(123) 18%(384) 69.40%(543) 65.30%(78) 5.80%


Source: MRCGP annual report

Readers' comments (10)

  • if you are an ethnic minority doctor or img please do not subject yourself to GP training. At worst you might be referred to the GMC if you fail this absurd exam

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  • this is encouraging news. we need to get away from the ' one size fits all ' approach. IMGs have slightly different GP training needs as there is less stress on communication skills and more on basic medical, theoretical / clinical skills in undergraduate / postgraduate training.

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  • When the final history of the NHS is written this will be regarded as by far the most bizarre episode
    the suggestion that members of the Royal College are racist will appear bizarre to anyone who has had contact with them
    . Nevertheless seven years after the introduction of new MRCGP South Asian doctors are 10 times more likely to fail than their Caucasian colleagues
    A deanery is an autonomous body not answerable to the GMC and indeed not answerable to anyone, though their training should be in line with GMC guidance
    . It is beyond question that a deanery is not technically capable of both selecting and training. They may well be competent in one of these roles, but not in both yet they retain responsibility for both
    Somewhere in the NHS , there sits a senior executive responsible for funding the deanery and indeed for the training grants and salaries of all those Indian doctors who were appointed in the certain knowledge that the majority of them fail
    as a non-training GP. I am incessantly bombarded with information and audits requiring ever tighter financial control to the point of absurdity. Where patients tablets must be supplied in the cheapest formulation. However unacceptable clinically
    and yet our senior executive is never questioned never held to account never required to justify his spending of millions of pounds of precious taxpayer money for such poor results

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  • We need to be asking some serious questions about training. These are just a few:

    It is clear that the needs of IMG graduates, White UK graduates and perhaps even ethnic minority UK graduates are different. With that in mind why are they trained together where the needs of one group (normally the majority) over-ride the needs of the smaller groups?

    Should people be given different lengths of training courses based on a score at the selection centre? i.e. top ranked enter a 3 year training programme, whereas those struggling could be given a 5 year programme. It seems crazy that a competency based assessment programme has predetermined, one size fits all, training lengths. The same should apply to the number of out of hours sessions that each person has to attend.

    Finally and perhaps controversially, should ethnicity gender and country of training be independent variables in the decision making for above. i.e. White, female, UK graduate who does pretty well in selection centre gets a 2.5 year training programme. Indian trainee, trained in Mumbai, gets the same score in the selection centre - gets a 4 year training programme.

    One trainee feels hard done by because their training takes twice as long.
    The other trainee feels hard done by because their training gets half the resources of the first.

    At least it annoys them in a fair and balanced way.
    Slightly radical, but that might be what is required.

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  • I find it hard to believe there is racism. I am a UK trained asian graduate and scored highest in my VTS in the CSA despite sitting it very early. The second highest score in my VTS was also obtained by a asian UK graduate. Before someone states oh the rest of your colleagues must be IMGs. The answer to this is NO. We scored far better than any of our 'white' UK graduate colleagues. The exam is based on communication skills, medical knowledge and clinical ability. Having practised with some IMGs I can understand why they would fail the exam and cannot blame racism as the cause.

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  • @6.47;
    Im also a UK born and trained Asian graduate. I scored highly in my CSA/ AKT and passed on my first sitting without difficulty. The results here are complex . On one hand we can certainly explain cultural differences for why IMGs are likely to struggle in this examination, but why are UK trained non white doctors far more likely than their white counterparts to fail? Also even if cultural factors are taken into consideration why are candidates who went to medical school abroad up to 15 times more likely to fail? No one has suggested that examiners here are right wing fascists or openly racist! , the issues here are far more subtle and complex and unconscious bias may play a large role. This issue has profound implications for future training/ recruitment/ retention and also the reputation of the RCGP and i'm glad they finally seem to be taking the issue seriously

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  • Who are the RCGP trying to kid here! You have scared away any potential trainees into general practice and now think your roadshows will help!
    Dream on.......

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  • When compared to 2011-212 now there is a sudden increase of 15% pass rate in IMGs as a result of the legal action. LAUGHABLE AND DISGRACEFUL !! Legal action seem to have suddenly eliminated the cultural differences and improved the communication skills of the IMGs. It is blatantly clear the explanations given by the RCGP in regard to CSA failure rates are contradicts and in conflict with the statistics and their own explanations.
    The cohort of trainees prior to legal action paid the ultimate price for this blunder caused by very people who supposed to support and protect them.

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  • Another institutionalised, out of touch, out of their depth, inept bunch of medic wreckers.

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  • I cannot claim to be able to explain the difference in pass rates. All I can say is that as a trainee some years back, i failed the exams a few times, not even managing 50%.
    This despite the fact that I went to Oxbridge, held a postdoctoral degree from same, as well as a post graduate surgical qualification from a Royal College - not to mention peer reviewed publications in medical/scientific journals. Despite over 20 letters after my name, I could not pass the exam.
    i assumed that I was not clever enough, so gave up on the MRCGP.
    I never blamed the exam at any point. I have always said that if a candidate scored every question correctly, you cannot fail.
    My training practice had all the GPs with membership, and two were, I seem to recall, were members of the RCGP Council.

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