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RCGP fails to stop BME trainees falling behind in exam results

Exclusive The gap between white doctors passing the MRCGP final exam and their black and minority ethnic (BME) peers is the widest ever recorded, despite the college vowing to address the issue three years ago.

A Pulse analysis of pass rates for the Clinical Skills Assessment part of the GP qualification exam found 93.8% of white UK-educated trainee GPs passed the exam at the first attempt last year, compared with 80.1% of UK-educated BME trainees. This gap is the widest since the RCGP started collecting figures in 2008.

The analysis also reveals fewer BME international medical graduates pass the CSA first time than ever before.

The RCGP was taken to judicial review by the British Association of Physicians of Indian Origin (BAPIO), which was concerned about the fairness of the CSA.

The RCGP won the case, but the judge emphasised that the ‘time has come to act’ on the differential rates, adding that ‘if it does not act… it may well be held to have breached its [Public Sector Equality Duty]’.

RCGP chair at the time Dr Maureen Baker said the college ‘agrees that further action is needed, and we are already working hard to find the best way of supporting the small number of trainees who fail to pass the CSA’.

The RCGP put in place measures designed to rectify this, including:

  • A college-wide review of equality and diversity.
  • More frequent CSA diets to allow candidates greater flexibility and control about when then sit, and more preparation courses.
  • An exceptional fifth attempt for both the AKT and CSA for trainees who have passed one or other of these assessments.
  • Frequent meetings with international doctors groups, including BAPIO.

However, the most recent figures suggest these measures are not having the intended consequences.

BAPIO president Dr Ramesh Mehta told Pulse: ‘It is frustrating that, in spite of the meetings, there is no change. Things are indeed even worse.’

He said BAPIO is pushing for three further changes: for assessments to take place in real consultations, rather than using actors; for two examiners to be used instead of one to reduce the potential for unconscious bias; and for assessments to be recorded to help candidates understand their mistakes.

Professor Aneez Esmail, professor of general practice at the University of Manchester, who was previously commissioned by the GMC to conduct a study on discrimination in the MRCGP exam, told Pulse: ‘I feel very angry, because they’re putting their head in the sand over this. I think the fundamental problem they have to understand is the exam structurally discriminates.’

But RCGP chair Helen Stokes-Lampard said the college is ‘transparent about and committed to addressing’ these differentials.

She told Pulse: ‘We are confident the MRCGP is a robust assessment of a GP trainee’s clinical knowledge and communication skills – both of which are essential to practise independently and safely as a GP in the UK.’

RCGP Associates in Training Committee chair Dr Duncan Shrewsbury said the college had been working with the Royal College of Psychologists on the issue.

Dr Shrewsbury told delegates at last month’s GP Preparation Conference in Birmingham: ‘There is an issue around whether the CSA is truly a reflection of reality.

‘For example, in inner-city Birmingham, do you see patients who all speak English, are white and middle class? No.’ However, he added that the CSA is considered ‘gold standard compared with international equivalents’.


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