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Letter from RCGP on fairness of CSA exam

Dear Colleague,

We are writing to set the record straight on the MRCGP examination in light of the recent claims of bias towards international medical graduates (IMGs) in the Clinical Skills Assessment (CSA).

This is a sensitive issue but please be assured that we are treating this accusation very seriously and that a lot of work is going on behind the scenes.

We have already met with representatives from the British Association of Physicians of Indian Origin (BAPIO) and the British International Doctors Association (BIDA) to discuss their concerns. It was a productive meeting and we hope that we are now in a constructive dialogue for moving forward.

A further meeting is being arranged for early in the New Year, to which we have also invited medical educators from COGPED and representatives from the BMA GP Trainees sub-committee.

We have both experienced the exam at first hand in recent days. I (Ben) sat a mock CSA examination in the examination centre last weekend and was reassured that the process was professional, fair and well organised. I (Clare) attended the CSA exam to observe the process. I met the actors and examiners and was extremely impressed by the high standards.

The RCGP sets the standards for general practice in the United Kingdom. In order to consistently improve patient care. It is essential that our assessments are as valid, reliable, quality assured and rigorous as possible.

The CSA is a reliable exam that reflects the diversity of general practice and the diversity of our patient populations. It is designed to test the complex tasks that make up a GP consultation, namely the ability to apply and integrate your clinical, professional, communication and practical skills to the general practice setting and communicate clearly and effectively with all patients whatever their situation .

Along with the two other components that make up the MRCGP qualification, the CSA has been carefully designed to ensure that new GPs are competent and safe enough to cope with the challenges of independent general practice.

All CSA examiners are experienced GPs who themselves are subjected to constant training, scrutiny and monitoring on equality and diversity. They work very hard to deliver an exam that is consistent, just and fair to all who take it.

This is an issue on which we have done a considerable amount of research. The RCGP is one of only two of the Royal Medical Colleges to routinely monitor data relating to examiner and candidate ethnicity and we have found no evidence that examiners favoured their own gender or ethnic group.

Researchers have recently reviewed 52,000 cases and found no substantial effects of gender or ethnicity on examiner/candidate interactions. In addition, the Applied Knowledge Test (AKT), which is anonymised and marked electronically, shows similar patterns to the CSA. Of the International Medical Graduates who pass the CSA first time, 40% score highly.

On the subject of fairness, the RCGP undertook an exit survey of candidates before they knew their results in February 2011. In answer to the direct question ‘Is the CSA fair?’ 92% answered ’ yes ’ . Of the failed candidates, about twice as many thought it was unfair as the passing candidates. We will be doing another candidate survey in February 2013.

We appreciate that as trainees you have already been through years of medical education and that the exam process can provoke some anxiety. But , as in any exam, a pass cannot be guaranteed just because you have completed your training and paid to take the exam.This would be a great disservice to you, the College and, most importantly, to patients.

We will continue to monitor this situation and explore the reasons why certain candidates continue to fail and work collaboratively with other organisations to see how we can offer advice to those in this position.

We are preparing a set of comprehensive FAQs that we hope will help to reassure you and we will, of course, keep you informed of developments and the outcome of future meetings.

The College greatly values its trainees and is fully aware of the pressures you face. This current situation is unpleasant and upsetting for all parties but we will see it through.

Thank you for all your support

Dr Ben Brown, Chair, RCGP Associates in Training Committee

DrClare Gerada, Chair, RCGP Council