This site is intended for health professionals only

At the heart of general practice since 1960

Read the latest issue online

GPs buried under trusts' workload dump

The RCGP needs to show it cares about BME exam pass rates

Editor's blog

When I first started as a reporter at Pulse in 2012, I went to my former editor with a potential story: that an international doctors’ group was thinking of taking the RCGP to court over its clinical skills assessment. Seven years later, my reporter said the exact same words to me.

The issue of high failure rates of black and minority and ethnic (BME) GP trainees – including UK-trained candidates - taking the RCGP’s clinical skills assessment has, therefore, been around for a long time. And it has not changed a bit in the meantime.

Yet there has been a judicial review in that period that told the RCGP that it was ‘time to act’ on the issue. The judge indicated that, without change, a second judicial review around BME failure rates was likely to succeed.

Well, here we are. As our figures on p16 show, there has been no change in the failure rates. UK-trained BME candidates are faring worse than their white counterparts, and international BME medical graduates do even worse proportionally than their white counterparts.

Some of the latter can be explained away by culture. And it’s true that UK-born BME students have worse results than UK-born white students in all areas of education, including the RCGP’s own applied knowledge test. There are hugely complicated reasons for these why this is. I won’t claim to know these, and even with the best will in the world, the RCGP would struggle to swim against this societal tide.

And there is a strong argument that we can’t simply decrease standards to make the CSA easier to pass. This would be in no-one’s best interests: patients, other GPs and even the trainees themselves.

I do believe there are particular characteristics of the CSA that means these differentials are a bit more problematic for the college, though. It is a subjective exam, and it is based on a particular form of general practice, where the patient population – ie role players - are predominantly white, middle-class, middle-aged women. This is very different to much of the general practice faced by GPs in Newham, east London, or Blackburn, for example.

There's been no change in CSA failure rates since the judicial review 

But, for me, the biggest problem here is that the RCGP is giving the impression of seeing the problems as an inconvenience. It continues to maintain that its own reviews – which were published with little fanfare last year – had found nothing wrong with the exam. It has made what Professor Aneez Esmail - an expert on the issue who wrote the GMC-commissioned review of the exam – called ‘superficial changes’. Throughout the whole judicial review, the college took a defensive line.

There is another way. Take a look at the GMC’s response to the furore following the Bawa-Garba case. Regardless of your views on the regulator, I feel it has shown it is willing to tackle similar problems head on. It commissioned its own review into why there were more complaints against BME doctors than white ones, and why BME doctors are more likely to be investigated. I’ve said before, but chief executive Charlie Massey deserves credit for answering difficult questions on race and Bawa-Garba at BAPIO’s own conference.

It may be that the GMC’s review will lead to nothing – the recommendations were, after all, pretty weak, focusing on developing leadership and mentoring. But the willing on the part of the GMC is clear.

I have a lot of respect for outgoing RCGP chair Professor Helen Stokes-Lampard. She has done a good job in treading the line between highlighting the crisis in workload and developing an optimistic view of the future, even if some of it might be wishful thinking.

But one of the biggest challenges for the next chair of the RCGP is to acknowledge the problems with the CSA, and show that the college is genuinely keen to address them. One-third of GPs are BME, and unless the RCGP fully recognises there is a problem and proactively does something about it, there is a danger that it will lose more credibility.

Jaimie Kaffash is editor of Pulse. Follow him on Twitter @jkaffash or email him at editor@pulsetoday.co.uk

Related images

  • jaimie kaffash 2 duo 280x131px

Rate this article  (4.78 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 (23)

  • Interesting as a UK born BME Doctor I honestly don’t know what to think!

    I can’t understand why UK born BME doctors would fare worse??!! Cultural differences have been cited but I don’t k is how much of this would impact on an exam

    Maybe having more BME patients in the exam and BME doctors assessing be a start?

    Unsuitable or offensive? Report this comment

  • We need a bit less optimism, forever hoping that things will get better, and a bit more realism and honesty. RCGP only has credibility among its gong-hunting buddies at the BMA and GMC echo-chambers

    Unsuitable or offensive? Report this comment

  • Why not take a good deal of the subjectivity out of the equation, and have real patients with clinical signs and examiners who can actually competently elicit them?

    Some time ago I had a patient who, on taking some social history, proudly stated they were an "actorrrr for the GMC doing PLAB exams". I will leave how the consult went to the readers imagination, and if the description of the typical role player was 110% accurate, or not.....

    Unsuitable or offensive? Report this comment

  • The establishment does not give a s@@@ about the boots on the ground, they look on us a plebs to stand on to achieve their political goals and gongs.We are useful to stop them getting their hands dirty.Although it seems the GMC,BMA,RCGP and CQC will have difficulty wipe the lifeblood of the medical profession of their hand as they help this government do their dirty work.Can you believe @unt saying he had saved the NHS last night!!!!!!!

    Unsuitable or offensive? Report this comment

  • Interesting they talk about not reducing standards but we have an army of ANPs/APs/PAs (and various other acronyms) that seem to be circumventing the previously rigorous training and examination system and working alongside or instead of doctors.

    Unsuitable or offensive? Report this comment

  • THIS ⬆️⬆️⬆️

    Unsuitable or offensive? Report this comment

  • why?

    Unsuitable or offensive? Report this comment

  • I once went to do the GP selection test just to test the waters on this claim and came out with a strong conviction that the allegations are true. The actors and examiners exhibited an implicit unconsious bias towards my colour and accent. The thing that hurt me most was that my own race were the worst in showing these non verbal cues. Probably they think they have now metamorphosised and have been accepted as the local white british when they reach a certain level. Pity their narrow midedness- "God of small things"

    Unsuitable or offensive? Report this comment

  • Its well proven we bond better and quicker with people of a similar ethnic background to ourselves. This is usually a by a tiny amount but over a large social interaction (which the CSA is) the net result will be a lower pass mark for those whose background is not adequately represented by the mock patients and examiners

    Unsuitable or offensive? Report this comment

  • Reasons for differential pass rates b/w UK BMEs vs White candidates:
    1. Quality of secondary/6th form education
    2. Medical school pass rate
    3. VTS training- poor rankings - means long commute to training practice - exhaustion. Poor performance. Bullying- BMEs more likely to perceive bullying as an issue. This was the case for me.
    Trained in KSS deanery, all the black trainees requested transfers due to “issues” with trainers.
    4. CSA exam is an issue - cannot explicitly prove bias but there are red flags. Only one adjudicator, actors are not standardised.


    Unsuitable or offensive? Report this comment

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

Have your say