This site is intended for health professionals only

At the heart of general practice since 1960

Read the latest issue online

Gold, incentives and meh

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’.


august 2017 data lowdown 580x615px


Rate this article  (4.29 average user rating)

Click to rate

  • 1 star out of 5
  • 2 stars out of 5
  • 3 stars out of 5
  • 4 stars out of 5
  • 5 stars out of 5

0 out of 5 stars

Readers' comments (26)

  • Did the CSA last year, very unlike real practice. Am BME and UK trained. I think the exam should be an observation of the doctor during a real consultation, with real patients and real signs. So many excellent BME doctors lost because they can't act or talk the perceived CSA style.

    Unsuitable or offensive? Report this comment

  • Houston we have a problem...

    Unsuitable or offensive? Report this comment

  • The problem is ill informed band wagon jumping.

    Unsuitable or offensive? Report this comment

  • Council of Despair

    do the other royal colleges have the same problem ?

    Unsuitable or offensive? Report this comment

  • This comment has been moderated

    Unsuitable or offensive? Report this comment

  • I think we need a better understanding of the statistics before we declare it unfair. Most importantly we have to correct for entry standard. If you think it is as simple as comparing pass rates for different groups you need to revise your statistics.

    My understanding is the CSA results for groups match fairly closely the trainees' performance at the entrance to GP training.

    And my personal experience is those ethnic groups who score highest in the CSA are least likely to include:
    -people who choose GP training after failing to get in to another speciality
    - people who go in to GP training after starting and leaving another training programme.
    - people who had to apply for more than 1 year to get in to GP training.

    We can (I think) agree that those groups represent a higher risk of failing a training programme/ exam; so by definition IF they are over-represented in certain ethnic groups then those groups should have a higher fail rate.

    For reference London training scheme fills up in round 1 of GP selection. Our area is mostly round 2 or 3 trainees. People are not surprised that out area does worse in the CSA. It is not because people are prejudice against trainees outside London.

    Unsuitable or offensive? Report this comment

  • All the Royal Colleges have exactly the same problem.

    Unsuitable or offensive? Report this comment

  • Council of Despair

    if it is the case that all the other royal colleges have the same problem then it may be unfair to bash the RCGP on this one (I am no fan of the RCGP).

    it may be better if all the colleges got together and looked into this?

    Unsuitable or offensive? Report this comment

  • What world do you guys live in? Above 3 comments. I don't know if you ever sat CSA. This has nothing to do with statistics, entry standards or career decisions.

    Everyone knows its just a money grab from BME, especially BME international graduates. By all Colleges. That simple. Nothing more nothing less. This has been going on for decades with every college!! How else would the college get funded with ever dwindling membership? Many leaving country and many leaving the membership inside UK.
    I still remember a quote from a Female hospital colleague, " He was my reg, when I was SHO. He knows a lot more than anybody I knew in this whole hospital. But he failed and I passed. I know they make it difficult for you guys to pass."

    Make few rules - reduce the exam fees, none of the fees from exams goes to Colleges for any expenses other than trainees, reduce the pay, no luxury biscuits, no natural mineral water - (just tap water is enough), no five star treatment or accommodation paid for for GP examiners, stop hiring Royal stage actors for exam - everyone would pass first time. Stop the exams being a business opportunity and profit based exercise for colleges.

    If you want to test communication skills and English language ask candidates to take IELTS - standard English test all over the world.

    CSA exam has no real world bearing either for communication skills or medical knowledge.
    Just a game.

    P.S - I took exams with 3 different royal colleges. Above info is from real world personal experience.

    Unsuitable or offensive? Report this comment

  • The CSA is designed to produce controllable cardigans. Their membership numbers are in a very steap nose dive lets not forget.

    Unsuitable or offensive? Report this comment

View results 10 results per page20 results per page50 results per page

Have your say