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RCGP study finds CSA exam is fair

Exclusive: The RCGP has revealed that a major study into the CSA exams  found ‘no substantial effects of gender or ethnicity on examiner/candidate interactions’ in an effort to ‘set the record straight’ on accusations that the exam was biased against international medical graduates.  

Dr Ben Brown, chair of the Associates in Training Committee and RCGP chair Dr Clare Gerada sent a letter to all associates in training today (Friday 21 December). It said that a review of 52,000 cases, carried it out in conjunction with King’s College, had shown the exam was fair and that there were ‘no substantial effects of gender or ethnicity on examiner/candidate interactions’.

The RCGP said the full results of the survey would be released in the new year. It also said the RCGP will undertake a survey of candidates’ views of the exam in February.

Figures from 2010/11 show that the failure rate for international graduates taking the CSA component of the MRCGP was 63.2%, compared with 9.4% of UK graduates.

The British Association of Physicians of Indian Origin has said it is considering a possible judicial review if talks with the RCGP do not provide a resolution.

Dr Brown and Dr Gerada wrote: ‘This is a sensitive issue but please be assured that we are treating this accusation very seriously and that a lot of work is going on behind the scenes.’

‘The RCGP sets the standards for general practice in the United Kingdom. In order to consistently improve patient care, it is essential that our assessments are as valid, reliable, quality assured and rigorous as possible.’

Both doctors sat mock CSAs in recent days, the letter said, and they were ‘extremely impressed by the high standards’ of the examiners and actors and were ‘reassured that the process was professional, fair and well organised’, they said.

They wrote: ‘The CSA is a reliable exam that reflects the diversity of general practice and the diversity of our patient populations. It is designed to test the complex tasks that make up a GP consultation, namely the ability to apply and integrate your clinical, professional, communication and practical skills to the general practice setting and communicate clearly and effectively with all patients whatever their situation.’

READ THE COLLEGE’S LETTER HERE

The RCGP is one of only two royal colleges that routinely monitors candidate and examiner ethnicity, they said.

They added: ‘Researchers have recently reviewed 52,000 cases and found no substantial effects of gender or ethnicity on examiner/candidate interactions. In addition, the Applied Knowledge Test (AKT), which is anonymised and marked electronically, shows similar patterns to the CSA. Of the International Medical Graduates who pass the CSA first time, 40% score highly.’

‘We appreciate that as trainees you have already been through years of medical education and that the exam process can provoke some anxiety. But , as in any exam, a pass cannot be guaranteed just because you have completed your training and paid to take the exam.This would be a great disservice to you, the College and, most importantly, to patients.’

The letter added: ‘On the subject of fairness, the RCGP undertook an exit survey of candidates before they knew their results in February 2011. In answer to the direct question “Is the CSA fair?” 92% answered yes. Of the failed candidates, about twice as many thought it was unfair as the passing candidates. We will be doing another candidate survey in February 2013.’

Readers' comments (306)

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  • I think all of us must stop wasting our time and effort anymore debating on this issue on this forum. Enough has been said already from both sides. It looks like two kids fighting over an ice cream. When did you last see any Prestigious academic institutions president fighting corners on a public forum like a child? - disgraceful.

    Let the law of the land decides who's right and who's wrong.
    BAPIO and RCGP - get your court papers in order and enjoy the festive period. Restart the debate in new year and put this issue to rest one way or the other.

    Seasons greetings.

    Andy Wilbrahm
    Freelance journalist

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  • I agree that these statistics appear upsetting, and I can see why those on the 'wrong end' of them feel injustice has been done.
    But....
    Don't forget there is more than one component to the nMRCGP - it's not just the CSA.
    Those arguing that "you can pass without clinical skill" should remember that the AKT and WBAs cover this aspect.
    There's no denying the CSA is a communication exam - and there's no denying those raised and trained overseas are BOUND to be at an immediate disadvantag. The subtleties and nuances of the English language are challenging enough for UK trainees to employ during the CSA, so is it any wonder IMGs souls struggle.
    This isn't saying anyone is lacking clinical knowledge or intelligence - far from it: I personally applaud those who can grow up in country A, train in country B, and work in country C (I certainly couldn't magnate this!). But there are aspects of communication that 'being intelligent' cant teach you.
    From a personal experience, a LOT of the IMGs in my VTS have repeatedly failed the CSA (and the AKT for that matter), but they are also way behind on the WBAs. I can honestly see a lot of these failing the programme - what is important is the show the trainees have 'been trained' as best as possible, and if this is the case, then it must be accepted that some people simply aren't suitable to be GPs (much as I will never represent the UK at the 110m hurdles, no matter how much coaching I receive...)

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  • Apologies for the obvious "autocorrects" up there... ^^

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  • This defensive stance is really saddening. The College is supposed to champion fairness and leadership. I totally agree with the problems with recruitment that are reflected in my locality. Many talented Doctors are being thrown in a scrap heap. I am seriously considering withdrawing my College membership. Don't know if I could affiliate with an institution that can't even look at it's own practice properly. The whole situation is a shambles and inspires no confidence in the public or College members. What a sad way to end the year.

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  • Qamar

    Please donate half of your membership fee to CSA legal challenge and support fairness and justice!

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