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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.’