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BMA to support international doctors’ legal challenge to MRCGP exam

Exclusive The BMA is to gather evidence in support of international doctors’ legal action against the RCGP and GMC over the college’s controversial MRCGP exam, and has pledged to look at how it can ‘further support’ their challenge in the courts.

The association has until now held back from involving itself in the judicial review of the MRCGP, which is expected to get underway early next year. But after an exchange of letters with the RCGP earlier this month and a meeting yesterday with the British Association of Physicians of Indian Origin (BAPIO), which has launched the challenge, the BMA said it will draft an ‘impact statement’ detailing how members have been affected by the exam.

The announcement comes as a Pulse survey reveals that 58% of GPs believe the college’s handling of the controversy over failure rates among international medical graduates and ethnic minority doctors in the clinical skills assessment has been ‘poor’ or ‘very poor’.  

The judicial review will look into whether the MRCGP exam is directly and indirectly discriminatory, and will also look at whether the RCGP and the GMC failed in their duties under equality legislation. The RCGP and GMC reject the claims.

Dr Krishna Kasaraneni, chair of the BMA’s GP trainee subcommittee, said the meeting with BAPIO yesterday, attended by BMA chair Dr Mark Porter, had been ‘very positive and constructive’.

‘Following our discussions, the BMA plans to draft an impact statement which can form a part of BAPIO’s evidence in its judicial review case,’ he said. ‘We will also be asking our members to submit their own individual impact statements detailing how they have been affected by the CSA exam. In the next few weeks we will continue to discuss how we can further support BAPIO.’

‘The profession and the public need to have confidence in the way exams are run and our members should be confident that competition is fair. If there is a risk of bias, measures must be taken to address this.’

BAPIO president Dr Ramesh Mehta described the meeting as ‘very fruitful’.

He said: ‘The BMA is extremely supportive of our case against the RCGP and the GMC.’

‘They are completely committed to working together with us for this judicial review. They will support us with an impact assessment, and with raising funds.’

The BMA wrote to the RCGP earlier this month outlining its position following the publication of an paper in the BMJ by Professor Aneez Esmail, a leading expert on racism in the NHS who was commissioned by the GMC to review the MRCGP. Professor Esmail’s paper concluded that ‘subjective bias due to racial discrimination’ may be a cause of higher failure rates among IMGs and black and minority ethnic UK graduates.

However the college has consistently denied that the exam is in any way discriminatory or biased, and has cited Professor Esmail’s official report to the GMC on his findings – published on the same day as his BMJ study – which concluded ‘the method of assessment is not a reason for the differential outcomes that we have described’. 

The letter from Dr Kasaraneni to RCGP chair Professor Clare Gerada said: ‘The BMA represents a diverse membership and it is unacceptable that any of our members’ careers may be affected by any form of unfair bias. The profession, and the public, need to have confidence in the way examinations are run, and our members should be confident that competition is fair. If there is a risk of bias, measures must be taken to address this.’

‘The RCGP must now recognise that this matter must be urgently addressed and take the appropriate steps, as recommended by the independent review, to address them.’

The letter went on to list a number of possible changes to the exam, including some – such as videoing the examination, double-marking of borderline cases using video recordings and increasing the number of attempts candidates are allowed from four to six – which were not recommended in Professor Esmail’s review.

In her reply, Professor Gerada said the college was willing to discuss all the recommendations made by the BMA. However, she added that the report ‘found no evidence of discrimination’.  The reply said: ‘Like you, we are determined that those sitting the MRCGP should have a fair exam. It is our job to ensure that through a fair process all the doctors that 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.’

Meanwhile a Pulse survey of 578 GPs has found that a small majority do not believe the RCGP has handed the row well.

Asked how they would describe the RCGP’s handling of the controversy over the MRCGP exam this year, 4% said ‘very good’, 38% said ‘good’, 42% said ‘poor’ and 16% said ‘very poor’. The finding comes after it emerged the college took the unprecedented step of instructing its lawyers to write to the BMJ claiming that Professor Esmail’s paper was ‘defamatory’ and seeking changes in the wording.

Responses to a separate question in the same survey answered by 644 GPs also suggest a shift in attitudes to the MRCGP controversy. In December just 15% of GPs said they believe the exam is unfair to international medical graduates; this has now risen to 24%, although more – 39% - continue to believe that the exam is not unfair.

An RCGP spokesperson said: ‘The recent independent and official review of our exam commissioned by the GMC found no evidence of discrimination. As the review highlights there are indeed differences in the pass rates between doctors who are from white ethnic backgrounds and those who are from minority ethnic backgrounds, particularly international medical graduates. These are differences that exist across many medical specialities and in higher education more generally.’

‘The college has been very open about the differential pass rates for many years, and has commissioned and supported internal and external research to try and identify what the cause, or causes, may be. Indeed, we were also one of the first medical royal colleges to publish the exam results highlighting the differences. We have ensured that there is a diversity of ethnicity and gender in our examiners and role players. The percentage of examiners and role players who are from minority ethnic backgrounds is higher than that of the UK population.’

‘Our exam is in place because as a medical royal college, our principal responsibility is to the nation’s patients. It is our job to ensure that, through a fair process, all of 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.’