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Just 15% of GPs think CSA is unfair to international medical graduates

Exclusive Half of GPs believe the clinical skills assessment component of the MRCGP exam is fair to international medical graduates, despite claims that it is biased against them, a Pulse survey has revealed.

The survey of 226 GPs showed that 50% of respondents believed that the exam is fair to international medical graduates (IMGs). Some 35% were undecided, while only 15% said it was unfair.

The result comes despite concerns being raised by international doctors’ groups over the exam, with the British Association of Physicians of Indian Origin threatening to apply for a judicial review to stop the College using the CSA to assess trainees.

The assessment aims to test graduates on their abilities in a mock clinical setting. Actors play the role of patients and an examiner sits in to grade candidates who must pass 13 different patient scenarios.

RCGP figures show that the CSA pass rate for UK graduates is 91.8%, compared with 40.8% for international medical graduates - results that have led to an investigation by the GMC over the issue and the BMA to express concern over the way the College has dealt with the issue.

But the RCGP has consistently argued the exam is fair, and the results of the Pulse poll indicate that half of GPs agree.

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Dr Peter Davies, the RCGP’s Yorkshire faculty representative, said: ‘It’s a competency standard. Only those up to the standard should pass it. If IMGs need extra or different training then it needs to be provided somehow. But altering the standard or applying a variable standard is unprofessional.

‘This is about applying a standard fairly and consistently. All the examiners are doing that as fairly and conscientiously as they can.’

Dr Peter Windross, a GP in Hampshire, said: ‘We must maintain our standards or risk perputuating the perception that GPs are failed other-doctors. We do a good job and no one seems to notice or take us seriously.’

But Dr Steve Taylor, a GP trainer in Prestwich, Manchester, said he was convinced there was an inherent bias in the CSA.

He said: ‘They are not intentionally biased. The College has to pass a certain number of people and they pass the best ones on the day. Because it is a spoken exam, they are likely to be UK graduates. 

‘At the moment, the College is using the CSA as its failure marker – between 80% and 90% of all failures are through CSA. Realistically, they ought to be having around a third of failures through CSA, a third through the advanced knowledge testing and a third through the work-based assessments. That would probably end up being a little fairer, at least for IMGs.’

Readers' comments (47)

  • 50% of 226 is 113. Out of 113,, how many are white and actually have faced any discrimination ever.
    Out of 113, how many have actually sat CSA in its current format.
    Those who don't face any discrimination would
    obviously say it's fair for them!!! No one is arguing on that. The exam is unfortunately unfair to a sub group of people !! Hence, white Drs should not be participating in this survey and give opinion on something which they have never faced in their life.

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  • Dear All
    We can not ask the pulse not to get opinion from the white GPs. After all they all work hard towards good standard medicine. However, pulse can reveal the break down of the ethnicity of GPs
    If significantly higher percentage white GPs say fair and significantly higher percentage of IMG/BME GPs say unfair, there is a problem in the perception of the exam, like CSA itself

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  • Pass rate difference 91% and 40% are not acceptable for an exit examination. PLAB has pass rate of 25-35%. No one is taking legal action. We know that IMGs are coming from different background and the GMC has all the rights to screen those people- Language and Clinical
    Even then USMLE screening has over 75% pass rate
    Scenarios quite different for CSA.
    All the doctors, local UK graduates, IMG and BME all passed the same selection process examianation and went through the same UK TRAINING and end up in hugely different pass rate.
    3 possiblities
    1. Selection process flawed; in that case those UK white graduates who failed to get GP training can consoder a legal case against the CSA. Also patients group can consider lega case as they were exposed to those low grade and unsafe doctors
    2. Traning is bad . In those cases , tax payers can consider legal case as they wasted 200,000.00 pounds already in each of the trainee who were out of the training
    3. CSA is biased: In this case , IMG and BME can take legal case. This is what is happening now. If IMG wins the case CSA biased, If they loose the case Selection and training process should be revised.

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  • Doesnt pulse think that only 50% doctors feeling that CSA is a fair exam a significant proportion?? It would be more useful to state what proportion of these doctors had taken the CSA, how many were non-white. Like the CSA, opinions do not reflect the whole story.

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  • Where is the evidence that it is a fair examination??? Why is the college against a video recording if it states that its a fair exam?? Why does the college want to depict that overseas graduate are of poor standards?? Perhaps video recording will show that IMGs are equally good..... or local graduates equally bad!!

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  • Dear ALL
    The question is not all about good or bad // fair or unfair. If there is a perceived notion about IMG 's being indifferent to British culture and British jokes - why are they taken into training ??? Is it only to make use of service provider aspect. Why IMG's are not trained as accordingly with focus to improve their communication and developing understanding of British values. Why at the end of their training they are subjected to racial prejudice. Why only IMG'S are expelled and not White British graduates. RCGP // Deanary // Trainer all of them should be made accountable and not poor IMG - we are not refugees and it is only after hardships - IELTS // PLAB // COTS// CbDs // MSF // PSQ // DOPS // Reflective Log entries - You say we are not fit to be a GP. It is absolutely unacceptable - myself being an IMG have no other choice but to accept the insult. I think all the IMG's irrespective of Speciality or GP training should rise above , unite and give a beffiting response
    Poor IMG

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  • I will be accused of bias - but, in my opinion as a trainer and now Chair of College and as someone that has now watched several diets of the CSA - it is a fair and unbiased exam.

    Overall, around 1% of doctors sitting the exam are removed from training because they never pass it. These doctors also fail the computer marked exam AKT between 1-7 times (around 1/2 pass on first attempt).

    These doctors have their primary medical qualifications from all continents in the world - including UK.

    Those that fail most - as a percentage of those in that group sitting the exam, are from East Africa with those from West Africa having a high pass rate. Those with primary medical qualification from Pakistan have very high pass rates whilst those from Sri Lanka low. Those from the Levant have high failure rates in comparison to the numbers sitting the exam (though numbers are small).

    So what does one make of this?

    That examiners discriminate against Sri LAnkans but in favour of Pakistani Doctors? That the actors act differently with doctors from East AFrica but pass those from West Africa?


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  • Will Jaimie Kaffash be publishing as many articles about the CSA if it is found to be fair and the legal challenges unsuccessful?

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