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International doctors call on RCGP to follow physicians’ lead on exit exams

An international doctors’ association has called for the RCGP to use the Royal College of Physician’s exam as a template to prevent it developing a ‘bad reputation’.

The chair of the British Association of Physicians of Indian Origin (BAPIO), Dr Ramesh Mehta, said that talks were ongoing with the RCP on reducing the differentials between the pass rates of UK graduates and international medical graduates (IMGs) and praised the college for reviewing the issue, which resulted in the college throwing out an examiner who was found to be racially biased.

He called on all royal colleges to follow the RCP’s use of two examiners and real patients for its version of the clinical skills assessment.

Speaking to Pulse at BAPIO’s annual conference, Dr Mehta said the organisation had been in discussions with the director of the MRCP exams, Professor Jane Dacre, and the two parties are discussing the results of the MRCP exam.

Dr Mehta said that the RCP’s acceptance that there is an issue surrounding differing pass-rates between IMGs and local graduates is ‘a start’ that paves way for finding a ‘reasonable’ solution. He said: ‘We will have a roundtable with them [RCP] to sort out the problem and if we can sort out this one that will set an example for other colleges to follow.’

He welcomed the RCP’s use of two examiners and real patients. The RCGP assessment uses a single examiner and actors instead of patients.

BAPIO is currently undertaking legal action against the RCGP and the GMC over the differentials in the rates of UK graduates and IMGs passing its clinical skills assessment, which will result in a judicial review, likely to take place in February.

This followed a study in the BMJ that found that there could be an element of racial bias in the CSA exam. However, the RCGP said that a GMC-commissioned report similtaneously published by the same author, Professor Aneez Esmail, cleared the exam of racial bias, leading to a row between the college and Professor Esmail.

Dr Mehta Pulse: ‘I have no doubt that the approach to the RCGP examination is deeply flawed and there is a problem especially for IMGS. Whether the problem is training itself or whether there is subjective bias – I have a feeling both of these are important.

‘There is an unease amongst the profession that this sort of discussion about alleged inequality and racism among the RCGP may lead to bad reputation of the college. However I believe that we will find the solution and once we find it – the college will be in a much better position and will be much more respectable.’

Speaking at the conference, Professor Dacre said that although a study of the MCRP exam has proved it is clear of racial bias, ‘that was a single study and the results of that were very much about our exam and cannot be generalised to the rest of the profession where I think things may appear to be different.’

A former examiner had been discharged following an investigation, admitted the MRCP lead.

She said: ‘We have done some work looking to see whether there was evidence of sex or race bias. Our two examiners in one station have allowed us to do that statistically. We had one examiner who was found to be racially biased. That person is no longer an examiner.’

Dr Dacre told the conference that this method had helped solve the issue of gaps between IMGs and UK graduates pass rates.

The RCP says that the pass-rate gap between IMGs and UK trainees in the MRCP, taken by 24,000 candidates worldwide, is caused by its international reach. With centres opening internationally to allow candidates to take exams overseas the gap has widened and could be related to training rather than bias. Professor Dacre said: ‘Prior to that the gap between IMGs and UK graduates was diminishing.’

She insisted that ‘trainees are the jewel in the crown of the NHS’, and that ‘it is not acceptable for a competent doctor to fail the assessment if the assessment is unfair.’

During her presentation, Professor Dacre highlighted the issue of funding postgraduate examinations and that online systems are planned to alleviate costs to candidates.