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Independents' Day

Porter: RCGP must 'acknowledge there is a problem' in exam row

Exclusive BMA chair Dr Mark Porter has criticised the RCGP’s response to the independent review into potential racial bias in the MRCGP exam, claiming that the college ‘must be brought to realise’ it has to address the controversy.

Speaking at a dinner event at the annual conference of the British International Doctors’ Association in Burnley over the weekend, Dr Porter said the RCGP’s response to the findings of the review by racism expert Professor Aneez Esmail was ‘not good enough’, and it was ‘stunning’ that such a ‘respected author’ could not exclude the possibility of subjective bias.

Dr Porter’s comments mark the strongest criticism yet from the BMA over the controversy, after an independent review of the MRCGP by Professor Esmail found ‘significant differences’ in failure rates between different ethnic groups in the CSA exam.

Professor Esmail’s full report - commissioned by the GMC - concluded ‘the method of assessment is not a reason for the differential outcomes that we have described’, leading the RCGP and the GMC to claim that it had exonerated the clinical skills assessment.

But a separate paper by Professor Esmail - published in the BMJ at the same time as his report to the GMC, and based on the same research - concluded that that ‘subjective bias due to racial discrimination’ in the CSA may be a cause of higher failure rates for UK-born ethnic minority and international candidates taking the exam.

A furious row then erupted as Professor Esmail warned that evidence of racial bias must not be swept ‘under the carpet’ and accused the GMC of misrepresenting his research - a claim the GMC strenuously rejected.

The RCGP, which is currently facing a judicial review brought by international doctors seeking to declare the exam unlawful, has consistently denied that the exam is in any way discriminatory or biased.

Dr Porter told doctors at the BIDA conference dinner that the BMA would push for meetings with the RCGP to ‘get to a place where they acknowledge there is a problem’.

He said that both the GMC-commissioned review and the BMJ paper had ‘the same authors, the same data and pretty much the same conclusions if you read them’.

‘Though it is possible to hide behind the different use of language to say one exonerates the RCGP while the other condemns it, I am not sure either goes to that end,’ he said. ‘The point is, there is an issue there to be dealt with.’

Dr Porter said the BMA’s own study over the past six months had made recommendations ‘around ensuring the CSA includes a diverse mix of cases, that examiners are drawn from a diverse population, and that candidates should receive more feedback’.

He added: ‘We’ve drawn this up before finding out that Professor Esmail was making similar recommendations, which is good because his recommendations are based on solid and objective data whereas ours were based on a discursive examination of what was happening around the various royal colleges.’

Dr Porter said: ‘One of the reasons the RCGP finds itself in the firing line is because they have such good data that people can look through them and find statistically valid data for analysis, which cannot be said of all royal colleges.’

But he added: ‘Essentially, we have said what we are doing and what BAPIO are doing, but we have a royal college here that must be brought to realise what the problem is.’

‘Significant questions remain unanswered and putting out a press release last week that basically says “there is no case to answer here, move on and don’t look at us and we’ll get on with defending the Judicial Review” – that is not good enough.’

Dr Porter referred to a previous speaker’s mention of the fiftieth anniversary of Martin Luther King’s ‘I have a dream’ speech, and ‘tremendous changes that have taken place in some ways but not others’.

He added: ‘It is stunning that we can get to 2013 and find that a major royal college is running examinations from which a respected author can conclude that we cannot exclude the issue of subjective bias.’

The BMA would meet with the RCGP to discuss the issue, Dr Porter said: ‘We are trying to help the RCGP to get to a place where they can acknowledge there is a problem and have something done about it rather than saying “we have been exonerated” and we will be taking that forward in the next week.’

In a separate statement released yesterday, the BMA announced that Dr Porter met Professor Esmail last week.

Dr Chandra Kanneganti, a member of BIDA’s executive committee and a member of the GPC, said: ‘I’m happy that Dr Porter spoke about these issues. He also spoke about other issues affecting international medical graduates and we would like to thank him for highlighting these issues more than ever before.’

A statement from the RCGP said: ‘It is our job to ensure that, through a fair process, all the doctors who qualify as GPs meet the requisite standards for ensuring safe patient care. That is what the public expects of us, and that is what we deliver.

‘We take equality and diversity issues extremely seriously and we already take comprehensive steps to ensure that the exam is fair and equitable to all candidatesand are currently reviewing the recommendations in this area from Professor Esmail’s independent GMC-commissioned review of the MRCGP.

‘We have been well aware of differential pass rates for many years, as is the case with all medical specialties, and have worked very hard to understand the possible reasons for the differences. We are currently in contact about this matter with the BMA, the deaneries and the Academy of Medical Royal Colleges.’

‘We are extremely surprised that while Professor Esmail’s official GMC investigation found no evidence of discrimination in the RCGP exam, there are now media reports suggesting that the exam may be discriminatory after all.’

‘In the official and independent GMC report, Professor Esmail found that “the method of [the RCGP] examination is not a reason for the differential outcomes that…have been described. The CSA examination is based on a well established pedagogy which is internationally recognised and used widely in postgraduate examinations”.’

“He also said that: ‘Our observations suggest that international medical graduates are treated exactly the same as British graduates’, going on to say: ‘Lack of preparedness’ of international medical graduates ‘may be an explanation for the differences between the two groups’.

The High Court will next week hear an appeal by the British Association of Physicians of Indian Origin (BAPIO) against a decision to exclude the GMC from its judicial review on the CSA. The hearing will also announce the date of the full judicial review.


This was updated at 16:14 on Wednesday 9 October

Readers' comments (40)

  • Bma loses my subscription and membership once more

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  • Tom Caldwell

    Does the BMA acknowledge there is a problem with its response to threats to the NHS and our profession from the government? Do they acknowledge their response is simply not good enough? The RCGP response does I agree fall below what you should expect , but given the impotence the BMA displays against this government I think they are equally guilty of a charge of being not good enough.

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  • Unfortunately I doubt if any of this will lead to anything meaningful for IMGs

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  • @11:18 I presume you have two memberships! How can BMA lose you 'once more' if you've already left before, unless of course you keep coming back because you realise your mistake.

    The author of the report said 'subjective bias due to racism could not be excluded' - end of. Please feel free to actually read the reports before commenting next time!

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  • The CSA has become an embarrassment to UK general practice, a festering sore that will not go away....

    From an international point of view it is a discredited and toxic brand, the only rational solution is to scrap it and come up with something better (preferably blinded to creed and color). The RCGP is just delaying the inevitable if they think they can get away with this one.

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  • @12:16
    I don't know whether you managed to pass or fail this exam but can't agree more with your comment.
    You have summed up the whole issue so nicely.
    The toxic brand as you have mentioned is so precious for RCGP that they can't dare to scrap it.
    Its like the cigarettes which atleast carry a warning.
    I have spent 4 precious years of my life- 3 on completing everything and the last, on loosing whatever I had gained in those 3 years including my family, self confidence and so much money on all this. Atleast, the RCGP should stop all these people making a business out of all this by charging so much on courses.

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  • @12:16

    You summed it up very nicely.
    Those 13 actors and invisible examiners pick up something which has not been picked up previously by thousand of patients, hundred of senior colleagues in hospitals and practices.
    My 3 trainers ( all Caucasians ) couldn't find the reason for two failed attempts after numerous joint surgeries and video consultations. The only advice was to speak more 'british'.

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  • 12.45 and 1.24, sorry to hear about your woes. I did in fact pass the exam on my first attempt but I'm a white male so it wan't particularly difficult.

    The only thing I can suggest as consolation is that the market for medical care is now globalized. I'm sure something will come up if you fancy a move to a brighter climate with less damp, interminable grey skies, where your skills will no doubt be welcomed.
    (Tip - try New Zealand, I really enjoyed my time there).

    Unfortunately for the RCGP the more they invest in defending it, the harder it will be to do the honorable thing but you can't polish a turd so it will have to go eventually. This will be a bit too late for general practice as a major recruitment crisis is already well underway.

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  • BMA has been selectively active in past . I have been BMA member for 10 treats but stopped this year as I found them very unhelpful
    RCGP has lot questions to answer . Having gone through this highly subjective bias exam it is high time they accept the faults

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