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Independents' Day

Set a fair exam and we won’t need to retrain ‘failed’ GPs

Health bosses' concession to allow some GP trainees who fail the MRCGP back into training shows that the examination needs to change, argues Dr Kamal Sidhu

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I welcome the announcement from Health Education England that GP trainees will now be allowed to re-enter training after failing one of their MRCGP examinations.

I do, however, worry that this will have a very limited impact.

These trainees and their families have been left battered and bruised by a system that results in BME doctors being more disadvantaged. Some have already left the country to move to systems that respect their abilities and treat them with greater fairness.

Of those left, some have been left too scarred to consider any form of retraining. Is it really fair to subject the rest of them to more distress, when the assessment format and its deficiencies still remain?

It seems perverse to haemorrhage trainees through the MRCGP and then try to recruit them back

It seems the system is hesitating to recognise some of the injustice meted out to these trainees. The indirect conclusion of this new development is a recognition that there are trainees out there who can succeed to be competent GPs, but have been let down by the existing system.

It is also apparent that the current demand and supply imbalance, compounded by ambitious but empty promises of thousands of more GPs, is softening the hearts of the powers that be.

It seems rather perverse that we continue to haemorrhage trainees through the MRCGP and then try to recruit them back. Surely, the solution should be not to lose these trainees in the first place. A fairer assessment process that attracts junior doctors to general practice instead of acting as a barrier will be in the interests of all including the tax-payer.

At this juncture, when the tragic case of Dr Hadiza Bawa-Garba has thrown the whole medical profession into turmoil, there is a very strong feeling of differential and discriminatory treatment of BME doctors at every tier of the system.

We already know that the MRCGP has divided the training fraternity and that it became the subject of a judicial review. It remains a major cause of discontent with the College, especially amongst BME doctors.

There is no evidence the new MRCGP introduced in 2007 improved quality of care or that thousands of us who sat the old exam are any less competent.

Some people suggest that communication is the main reason that BME doctors struggle more with the new MRCGP and this makes them less competent and worthy of being a GP. This argument falters when you see that ‘second-generation’ BME doctors also have a higher failure rate despite being born and educated in the UK.

It is time this is put right so we can be assured that BME doctors present and future have an equal chance in these assessments, not based on their ethnicity or accent.

Surely, it is time that the college reconsiders its stance on the MRCGP. It owes it not just to members or the wider profession, but to every single patient who suffers from being unable to see a doctor or because their surgery is facing closure.

Dr Kamal Sidhu is a GP trainer in Blackhall, County Durham



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Readers' comments (17)

  • The exam needs to be objective.. They will be soon bringing back summative assessment given the current state of GP recruitment..

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  • Good article.To the point.

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  • AlanAlmond

    There’s one thing I don’t understand with the current dogma that BME Drs are routinely discriminated against. If this is the case how does this sit with the fact BME Drs are significantly over represented in the profession compared with the population they serve? Isn’t it the case BME Drs represent something like 30% of the workforce yet only around 10% or less of the population. Some of this is due to over seas recruitment, some is probably due to cultural biases pushing particular groups into particular professions but I can’t see this as evidence BME Drs are finding it difficult to get into medicine. Theres a sad lack of balance in these kind of debates which is unfortunate. I suspect I might be labelled for making this point. You either agree or you keep quiet. The end result are sterile discussions with people only debating issues with people who agree with them. Everywhere in PULSE are articles with people looking to set up ghettos dividing one kind of Dr from an other on the grounds of their sex or the colour of their skin. I cant see this as a good thing. Can we not try a little harder to try and stick together

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  • Good article, spotted quite well. Instead of CSA exam, it was better to call this exam as BME filtration exam. I hope RCGP would conclude sooner that this exam is not fit for purpose and those examiners who failed BME doctors on the basis of ethnicity/colour/accent/etc to be open and bring into light the fact they judged with bias.

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  • As usual - no reference to differential pass rates in the AKT. Simplistic partial view.

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  • Well, I believe that rather than criticising exam system, we need to work on supvisors training. In my view there must be research that what is pass rate for trainees under different supervisors in different areas of country. I am sure poor supervising standards are the main cause if repeated failure for IMGs who need dfferent and extra support. I believe that CSA and AKT standards must be higher as these are exit exams.

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  • So doctors can be callous, disinterested and fail to communicate to their patients as long as they can say that this is linked to the colour of their skin?
    The exam is not there to be "equal", it is there to ensure a certain level of ability.

    If there is a gender or race bias in how the exam is assessed, this should be addressed. If however for whatever reason a certain demographic of candidates fails more often to meet the standards then that is acceptable: I would want a good doctor, not one that happens to fit some sort of quota.

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  • @ policenthieves | GP Partner/Principal18 Mar 2018 9:04pm

    I am foreign and I trained outside the UK.
    My AKT results were way above average yet I failed my first CSA attempt. I couldnt speak I was so nervous. You see, local non-BME docs learn how to be confident and theatrical from a very young age. BME docs not so much ( we are talking differences in perecentages here not in general ). That is a cultural disadvantage. It is discrimination because the RCGP does not account for this, willingly or not, during selection and throught training. Not to mention the other cultural differences in how people communicate. If the RCGP expects a certain type of GP then they should provide full training for it taking into account country of origin and background. Discrimination is not always obvious especially if its not happening to you personally. First seek to understand.

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  • Council of Despair

    count your self lucky if you 'failed' - it should motivate you to go somewhere where you will be appreciated. why would you want to do a job that others are trying to get out from? things are set to get worse not better so don't feel bad if you have 'failed' - it isn't you that has failed it is the system that has failed you.

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  • Thank you Dr Sidhu for writing this article. Coming from you who is a GP trainer himself means a lot for ex GP trainees. Most trainees who have struggled with CSA have excellent colleague and patient feedback which is taken over a period of time in their training. Does the opinions of supervisors and real life patient which states a trainee to be competent to be a GP, carry no weightage when deciding about a doctors ability? Does just getting couple of marks less in a exam given under very stressful conditions speak about a doctors ability to practice safely?

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