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The MRCGP row has left lasting damage

The past few weeks have seen some extraordinary developments in the long-running row over the MRCGP exam.

A racism expert publishing two very differently worded versions of the same research. A threat of legal action against the BMJ. The RCGP and now the GMC forced to defend themselves in the High Court, with the prospect of a judicial review dragging on into 2014.

Suddenly, a controversy that has been simmering away all year is threatening to tear the profession apart.

Since Pulse first broke the story that international doctors were considering a legal challenge to the exam, there has been intense debate about the merits of the clinical skills assessment part of the exam.

But at the heart of the issue remain two facts. First, even after adjusting for age, gender and performance against the machine-marked applied knowledge test, black and minority ethnic international medical graduates are almost 15 times as likely to fail the CSA on their first attempt as white UK graduates.

And second - and this is the figure that really stands out - non-white UK medical graduates are 3.5 times as likely to fail as their white colleagues.

Quite why remains unclear. Those challenging the exam believe it is flawed, and Professor Aneez Esmail’s conclusion in his BMJ study - though not, explicitly at least, in his report to the GMC - was that ‘subjective bias due to racial discrimination’ may be a cause. There are other possible explanations though. The CSA is not a ‘culturally neutral’ exam and many IMGs come to it from ‘a different starting point’, as Professor Esmail himself acknowledges, stressing that the ‘preparedness of candidates, based on previous education experience’ could be a factor.

What is clear, though, is that with the benefit of hindsight, the RCGP might have handled the controversy better.
The college did initially offer international doctors some concessions, but it may now wish it had offered more, such as allowing the CSA to be filmed for use in appeals.

Instead, as legal action has progressed, the college’s position has become increasingly entrenched and, in time, it may come to regret the way it has responded to Professor Esmail’s criticism. RCGP chair Professor Clare Gerada had every right to express bemusement at the apparent contradictions in the wording of his two reports. But for the college to publicly attack one of the UK’s leading experts on racism in the NHS looks bad; to threaten legal action to try to force changes to the wording of his research paper worse still.

How the case will play in court remains to be seen, but in the court of public opinion the battle may already be lost. Our survey suggests a majority of Pulse readers feel the college has handled the affair poorly - even though only a minority believe the exam itself is discriminatory.

All of which presents incoming RCGP chair Dr Maureen Baker with a real headache as she takes the reins at the college this month.

Her instinct may be to let the affair play out in the courts. But regardless of how the judicial review goes, she also must acknowledge the blow to the MRCGP’s credibility, and the damage the controversy has caused to the college’s reputation. It will not be easily undone.

Readers' comments (25)

  • An exam which has a DEFAULT PASS RATE of 98% based on gender and colour can't be an exam to ensure public safety.
    Patient groups need to investigate the matter independently.

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  • well if you think the MRCGP exam might be bias against foreign doctors , wait till there is a legal challenge to the new requirement for overseas graduate who are GP's in their own country to get on the performers list , it will make the MRCGP exam look like a walk in the park
    the reason why I know is that recently we wanted to recruit a German doctor to come and work for us and it was such a daunting experience that she finally had to leave , she was Fluent in English and a knowledgeable clinician . I'm not aware that this exam has been externally validated but happy to be proven wrong .

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  • I am completely dismayed by the RCGP's response to this matter. At no point have I heard anyone from the college try to explain/justify the 3.5x higher failure rate for non-white UK graduates - yet they state repeatedly that there is no problem with the exam! I will definitely be ending my membership of the college.

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  • I can only wish and hope that Maureen Baker has better sense than CJ.

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  • The fiasco has been a humiliating shambles for the RCGP that wants to bury its head in the sand. As a UK trained minority ethnic doctor who has British Citizenship I feel ashamed to be governed and judged by the "RCGP". I now CANNOT WAIT to pass this stupid exam and run out of this country as soon as possible, never to come back. Good luck RCGP...

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  • Where are you going....?

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  • What a disgrace for the whole medical profession this Royal College has become. I am very disappointed indeed. Staggering statistics.

    RCGP - Please, please, admit that you made a mistake in the design and conduct of the exam ( not that you are necessarily intentionally racist) and work with all stake holders.

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  • My husband is a IMG with post grad surgery + 20 years experience. He has been married to myself for 16 years. I have a Masters and I am British UK graduate. His clinical skills are beyond reproach and his English perfect yet he still fails the CSA. The RCGP need to acknowledge Prof. Esmail's findings and rectify this shambolic assessment - actors are not real patients. My Husband even overhear one of the 'actors' saying to the examiner 'sorry I made a mess of that'. Stop ruining careers, marriages and families' lives. 'RCGP HEAL THINE SELF.'

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  • What about some of the current GPs, if they go to this exam may be only 5-10%should pass , as most of them are not following any guidelines but working on the old fashion style, using beta blocker as first line for hypertension etc....But they still can work for another 15-20 years without any delay in their career/ even the new trainees who passed some of them have very superficial knowledge as they ask Clexane should BE GIVEN M? FOR e.g.

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  • IM I meant.

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