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Independents' Day

RCGP fails to stop BME trainees falling behind in exam results

Exclusive The gap between white doctors passing the MRCGP final exam and their black and minority ethnic (BME) peers is the widest ever recorded, despite the college vowing to address the issue three years ago.

A Pulse analysis of pass rates for the Clinical Skills Assessment part of the GP qualification exam found 93.8% of white UK-educated trainee GPs passed the exam at the first attempt last year, compared with 80.1% of UK-educated BME trainees. This gap is the widest since the RCGP started collecting figures in 2008.

The analysis also reveals fewer BME international medical graduates pass the CSA first time than ever before.

The RCGP was taken to judicial review by the British Association of Physicians of Indian Origin (BAPIO), which was concerned about the fairness of the CSA.

The RCGP won the case, but the judge emphasised that the ‘time has come to act’ on the differential rates, adding that ‘if it does not act… it may well be held to have breached its [Public Sector Equality Duty]’.

RCGP chair at the time Dr Maureen Baker said the college ‘agrees that further action is needed, and we are already working hard to find the best way of supporting the small number of trainees who fail to pass the CSA’.

The RCGP put in place measures designed to rectify this, including:

  • A college-wide review of equality and diversity.
  • More frequent CSA diets to allow candidates greater flexibility and control about when then sit, and more preparation courses.
  • An exceptional fifth attempt for both the AKT and CSA for trainees who have passed one or other of these assessments.
  • Frequent meetings with international doctors groups, including BAPIO.

However, the most recent figures suggest these measures are not having the intended consequences.

BAPIO president Dr Ramesh Mehta told Pulse: ‘It is frustrating that, in spite of the meetings, there is no change. Things are indeed even worse.’

He said BAPIO is pushing for three further changes: for assessments to take place in real consultations, rather than using actors; for two examiners to be used instead of one to reduce the potential for unconscious bias; and for assessments to be recorded to help candidates understand their mistakes.

Professor Aneez Esmail, professor of general practice at the University of Manchester, who was previously commissioned by the GMC to conduct a study on discrimination in the MRCGP exam, told Pulse: ‘I feel very angry, because they’re putting their head in the sand over this. I think the fundamental problem they have to understand is the exam structurally discriminates.’

But RCGP chair Helen Stokes-Lampard said the college is ‘transparent about and committed to addressing’ these differentials.

She told Pulse: ‘We are confident the MRCGP is a robust assessment of a GP trainee’s clinical knowledge and communication skills – both of which are essential to practise independently and safely as a GP in the UK.’

RCGP Associates in Training Committee chair Dr Duncan Shrewsbury said the college had been working with the Royal College of Psychologists on the issue.

Dr Shrewsbury told delegates at last month’s GP Preparation Conference in Birmingham: ‘There is an issue around whether the CSA is truly a reflection of reality.

‘For example, in inner-city Birmingham, do you see patients who all speak English, are white and middle class? No.’ However, he added that the CSA is considered ‘gold standard compared with international equivalents’.


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Readers' comments (26)

  • What were the results of the machine marked AKT?

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  • White candidates should be confronted with a burqa wearing woman or a man with a long beard wearing pyjamas who speak "broken " english and lets see if they pass their assessment

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  • This should be the final nail in the coffin of the CSA. I am appalled - why should my daughter, born in England, trained at a reputable English grammar and then medical school, have a higher risk of failing the CSA just because she is racially 'BME'?

    The solution is not to have more BME examiners as that will be hideously expensive.

    What is the racial profile of the examiners?

    Therein lies the 'elephant in the room'- the exam is a highly paid jolly which this club of Morlocks (see Peverley's definition of Morlocks) guards jealously. Imagine: working in Central London instead of seeing patients - and being paid handsomely for this playing of charades? Why would this exclusive club suddenly become inclusive?

    And it is the poor (literally) exam candidates who pay a fortune for sitting this exam in order that the Morlocks earn a lot of dosh whilst enjoying a day out in London....

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  • Makes you wonder why they test the white ones, presumably the 6% failure is experimental error.
    So what happens if you test white, female 4th year medical students? do they all pass ?
    What happens if you test experienced white GP receptionists?
    What happens if you take non white, experienced GP's, who have just retired, after 30 years of unblemished service, with the tears of their patients ringing in their ears? do they all fail ?
    It is an intriguing exercise in oral choreography with definite esoteric entertainment value

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  • The two by far the best ST3 GPs I have met both failed CSA and their lives were devastated. Both disappeared from the local doctors pool where they were keenly welcomed. A great loss to our community. Needless to say both were BME.

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  • No wonder why junior doctors are reluctant to join GP training.
    Its a disaster for the BME trainees.

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  • How many BME faces do you see in NHSE top brass, Medical Directors/Senior Managers of Hospitals, Trusts and CCGs - you can count them on your fingers. Talk to the senior GPs and they quiver at the thought of standing up to the establishment and dissuade you from doing so because 'your colour is not right'.
    In hospitals, the junior BME doctors would tell you they stood no chance of getting into the VTS because of their ethnicity - true or not, this has been the general perception. The seniors tell you they stormed into general practice and there is a majority of BMEs in GP land due to the simple fact that when GP started, they could get out of the hospitals where they did not see any opportunity of progression to Consultant status.
    There must be some truth in that.
    Now, how many BMEs are there in the RCGP top brass?

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  • What happens if you send tapes of the test for external marking
    What happens if you relabel the BME tapes Samantha Fotherington-Smyth
    What happens if you activate voice recognition and send transcripts for external marking, again mixing up the names.
    At what point does the exam become colour blind
    Of course the BME candidates could just poke the examiner in the eye

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  • How about:
    1.Getting patients with physical signs ie not actors for the CSA;
    2.Get the Crowned Heads (examiners) of RCGP to examine them and see if THEY can make a coherent assessment; the performance of BME vs white UK graduates on these proper patients.

    That might be quite interesting......

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  • RCGP: Decentralise the exam, examine locally and don't ever try and state that any steps have been made to address this, when the main concession has been a further £2k examination attempt for the poor candidates they know are doomed to fail before they even hand you the cheque.

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