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New CSA figures reveal widening gap in first-time pass rates between IMGs and UK graduates

Exclusive The gap between the pass rates of UK graduates and international medical graduates (IMG) taking the clinical skills assessment (CSA) exam for the first time widened in 2011/12, official RCGP figures show.

The latest statistics show that 65.3% of IMGs failed their first attempt at the CSA exam in 2011/12, compared with 9.9% of UK graduates. In 2010/11, 59.2% of IMGs failed at the first attempt, compared with 8.2% of UK graduates.

But the overall failure rates between the two groups slightly narrowed, with failure rates for IMGs rates decreasing from 63.2% to 62.6% from 2010/11 to 2011/12, compared with an increase in failure rates from 9.4% to 11.5% for UK-trained graduates.

Although the RCGP says comparisions based on demographic variables should be done on the basis of ‘first attempts’ only: ‘Otherwise re-sitters will bias the results’.

The results come as the British Association of Physicians of Indian Origin confirmed it is pressing on with a judicial review against the college over the differential pass rates, which mean UK graduates are six times more likely to pass the CSA than IMGs. It also comes after the GMC commissioned an independent review into the MRCGP exam failure rates.

The differentials between white UK graduate and black UK graduate failure rates remained high, with 5.8% of white UK graduates failing the exam compared with 24.4% of black UK graduates.

The gap between the number of IMGs and UK graduates passing the applied knowledge test also widened. Half – 50.6% - of IMGs failed the AKT exam in 2011/12, compared with 46.5% in 2010-11. The number of UK-trained graduates failing the exam remained at 16%.

Chief examiner Dr Sue Rendel wrote: ‘Like most postgraduate medical exams, there are variations in their performance of various candidate subgroups in both the AKT and the CSA. Exploring and trying to understand the reasons for this has been a priority for the RCGP for the last few years.

‘Having taken the lead on a cross-specialty review of postgraduate examination data, we are pleased that the GMC have decided to require all colleges to report the results in a similar way to our previous years’ reports and anticipate that this will provide a rich and useful data set for investigating this issue across all specialties in the future.’

She also said that the King’s College analysis of the CSA exam results was due to be published in the spring. ‘Early results indicate that there will be considerable amount of material that can be used to develop a tool kit for helping trainees prepare for this module,’ she wrote.

Dr Kamal Sidhu, a GP trainer from County Durham, said: ‘While the college ought to be applauded for leading the way in providing these detailed figures, it is extremely sad and disappointing that it has failed to take any corrective steps. It is of utmost concern that trainees belonging to certain ethnicities continue to struggle in disproportionate numbers.The college cannot wash its hands of the matter by sticking to its stand that the examinations have no flaws.

‘The fact remains that many trainees continue to fail these examinations multiple times despite being competent in other assessment modalities. If they are unsafe after three years of training, something very fundamental is wrong with the process. Nevertheless, I remain extremely optimistic that the college will work towards reducing this disparity. The training community remains extremely worried about these trends and their impact on all concerned.’