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RCGP faces legal threat over international GP trainee failure rates

Exclusive: The RCGP is facing the prospect of legal action unless it makes changes to rectify the high failure rate of international GP trainees in the MRCGP exam.

Pulse can reveal that the British Association of Physicians of Indian Origin (BAPIO) is in the process of taking advice on a group legal action with regards to the examination – including the possibility of a judicial review.

BAPIO says the RCGP is not doing enough to address the ‘huge’ differential pass rates between international and UK GP trainees in the new MRCGP, introduced in 2010.

The move comes as the GPC trainees subcommittee also began discussing the issue, after it had a rush of emails about it. The British International Doctors Association also told Pulse it was planning to hold a meeting about the issue.

The move reignites a long-running row over the MRCGP. The RCGP commissioned a review of possible racial and sex biases in the exam in 2010, after the college admitted that ethnic-minority candidates were continuing to perform ‘differently’ to other candidates.

The latest available figures show that, in 2010/11, the failure rate for international graduates taking the CSA component of the MRCGP was 63.2%, compared with 9.4% of UK graduates.

BAPIO is set to meet college representatives in the first week of December and will contact the NHS Confederation and the GMC, but is taking legal advice on what to do if the disagreement is not resolved.

Dr Ramesh Mehta, president of BAPIO and a consultant paediatrician, said: ‘The discrepancy is so huge. All these people have gone through the same training for three years. Only the bad apples – maybe 2% or 3%, not 70% [should fail].

‘We want to solve this problem. It would be best to sort it out by discussion. But if we can’t, then we have to go down the legal route.’

When asked whether this meant a judicial review or individual actions, Dr Mehta replied that BAPIO was looking at ‘all possibilities’.

Dr Krishna Kasareneni, chair of the BMA GP Trainees Subcommittee and a GP trainee in Sheffield, said it was also due to discuss the issue at its meeting next week.

He said: ‘We have been getting a lot more emails over the past few days.  We will speak to the college about what we can do.’

A spokesperson for the RCGP said it was constantly monitoring the performance of international GP trainees: ‘The RCGP/Kings College London project is due to report in the next few months, the aim being to provide an analytical framework for developing supportive educational resources.’

But Dr Kamal Sidhu, a GP trainer in County Durham and an international medical graduate, said: ‘The royal college stands completely detached from the situation on the ground.

‘It is time that the college woke up to this grim scenario and started a practical and fair review of the examination.’

Dr Una Coales, an MRCGP course provider and a member of RCGP Council, said: ‘I am concerned there is a large difference in pass rates between UK and international graduates sitting an exam after three years of UK specialty training.’

Readers' comments (301)

  • Why not dumb down the exam because in 5 years time someone who is good at ticking boxes will have to replace all the early retirees.

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  • Maybe, the College should waive off the extortionate £1600+ fees it charges for the CSA for further attempts for any candidate (local or international) if they are unable to clear the exam on the first attempt. If a candidate fails, both the deanery and the college are to share the responsibility with the candidate. This would help control breaking the back of the severely frustrated GP registrar.(financially, psychologically, emotionally and physically!)

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  • Thank you BAPIO for figuring that out, well done.
    I am an internal graduate came for postgraduate study and go my MRCOG first attempt after 5 years of being servicing hospital jobs I decided to become a GP as least I can practice some of the gynaecology work, being career minded thought would do the MRCGP, guess what I failed the exam 3 times....imagine the frustration emotionally and the financial implications. I decided to write to the RCGP and their replay was that to pass the exam you need to be of very high standard ....so my standard is very high to pass MRCOG but not MRCGP.....after 5 years in general practice??????

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  • Nobody is going to have any confidence in revalidation after this disclosure.

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  • Vinci Ho

    The difference in pass rate is 53.8% , too large to have any excuses to defend. Last thing you want is media becoming interested in the story . Where can this go?

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  • I know some of the central examiners and to call them racist is an excellent example of profound ignorance - I would expect this from the Daily Mail, not Pulse readers. BUT I understand the frustrations as one (UK born, bred and trained) who struggled to get past the PC-minded bureaucrats in GP selection once-upon-a-time. The College is trying hard to raise standards and keep them there. Linguistic skills and interpersonal skills are vital to UK GP and we should welcome a raising of standards. The other colleges have very similar fees and higher failure rates and even less job guarantees in some circumstances. As a trainer looking at our local failing trainees it is obvious to me why MOST of them fail, but I do think that sometimes it is a little harsh. I regret I cannot offer a solution, just balanced observation as I would hope the other readers would do.

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  • Incredible that all of the comments I have read so far are placed anonymously.

    The fact of the matter is that physicians who are trained outside of the country cannot be expected to match the performance of those trained in the UK. The reasons for this are both cultural and academic.A family physician's training does not consist only of the preceding three years; it started before the time that they first attended elementary school.On top of that, medical schools vary a great deal in their quality of training, especially in countries where there are a lot of private medical schools.

    However, times have changed. When I was a student nobody ever dared to question examiners. Nowadays, with the modern concept of transparency, there are constant challenges to what examiners think. I suppose this is a good thing, and it reminds us that objectivity is the essence of examinations: it is the new order of things. This means either a lot of dependence on well-constructed multiple choice questions, or a team approach to examining in practical and oral examinations, incorporating the use of checklists. This is going to have to replace extreme trust in examiners' integrity. The bonus is that it will stand up to scrutiny by appeal bodies and by the courts.

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  • If a exam system is subject to this sort of criticism only after two yrs, then there must be some reason for it..clearly this exam cannot be classed as "standard" and Fair exam if it is clearly favoring one side of spectrum. What is all the fuss about.?.make some necessary changes to the system to make it more fair ans standard, after all we all learn from our experiences..

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