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Leading critic of MRCGP exam to chair BMA review of postgraduate assessments



The BMA has appointed a leading critic of the MRCGP exam to chair a wide-ranging review of all postgraduate medical exams, it has emerged.

Professor Aneez Esmail, who published a critical report on the clinical skills assessment of the MRCGP exam last year, will chair a panel – including the BMA, all the royal colleges, the GMC and Health Education England – charged with addressing the ongoing disparity in postgraduate exam pass rates between black and ethnic minority doctors.

Dr Krishna Kasarareni, the outgoing chair of the GPC’s training subcommittee, announced the review today, stating that the BMA wanted to take the lead on the issue by bringing all parties together.

Professor Esmail claimed his research showed that ‘subjective bias due to racial discrimination’ could not be discounted as a reason for disparities in the pass rates – claims which were strongly denied by the college.

Earlier this year, the college was cleared of charges that the exam was racially biased, but a court said that ‘the time has come’ for the college to act on the differential pass rates.

Dr Kasarareni announced the BMA review at the ARM during debate of a motion calling for the cap on re-sits of the MRCGP exam to be lifted until an independent review has taken place.

Dr Kasaraneni urged members not to support the motion, which was not passed, saying it could undermine the BMA’s efforts to take the debate forward and reassured delegates that the BMA was taking the lead on a review of the exam.

Dr Kasaraneni told the ARM: ‘The BMA is organising a think-tank that is going to meet in the first week of November, which is going to be chaired by Professor Aneez Esmail, who you know wrote the independent review… where we will have the Academy of Medical Royal Colleges, each of the royal colleges individually, the deaneries…  all together round the table, to look at all of the postgraduate exams, so we can make sure we look at the whole of the process and not just the exam.’  

Professor Esmail told Pulse the BMA was in a good position to broker a meeting between all concerned parties, and that he had agreed to chair the initial conference in early November.

Professor Esmail said: ‘Basically what they’re saying is, now that the judicial review is out of the way, can we have an honest discussion with the colleges about the exams and find a way forward.’

‘And let’s do that in an open manner, look at the evidence and try to find the best methods of assessing patients. It’s not just an issue for the RCGP but all the royal colleges.’

He added: ‘There are big questions – for example the use of actors in clinical competence exams and whether there are better methods – so it will be looking particularly in that area.  There is a big debate not only in this country about what is the best way to do this.’

‘In a way the judgment did say to the RCGP and the GMC, “you have to go away and look at this”, and certainly the other royal colleges have now said they do want to get consensus on this.’

The RCGP dismissed the suggestions that the exam may be biased last year, stating 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’.

It came after an international doctors organisation – the British Association of Physicians of Indian Origin – launched a legal challenge against the College over alleged bias against overseas medical graduates.

The judicial review ultimately ruled that the exam was lawful, but the judge presiding over the case said it was time for the RCGP to ‘eliminate discrimination’ and address the differences in failure rates between white and non-white medical graduates sitting the clinical skills assessment (CSA) – the role-playing test of GPs’ clinical and communication skills.

This month, the college, BAPIO and the British International Doctors Association announced in a joint statement they would be developing initiatives to help struggling international and black and minority ethnic trainees so they were better prepared for the exam and independent practice, following a joint meeting between the groups.