The BMA said ‘significant questions’ still remain unanswered on whether subjective bias is a factor in the marking of the clinical skills assessment, following the final publication of the GMC-commissioned review of the MRCGP exam.
Dr Krishna Kasaraneni, chair of the BMA GP Trainees Subcommittee said the BMA would meet the authors to discuss the issue of subjective bias and broader issues around the lower pass rates of graduates from certain groups.
Dr Kasaraneni welcomed the report’s recommendations around including a diverse mix of cases, drawing examiners from a wide demographic pool and giving candidates more detailed feedback.
He also called for further research into what happens to trainees forced to withdraw from training, whether the Annual Review of Competence Progression which assesses progress is fair and asked deaneries to research variations in pass rates.
Currently the RCGP is facing a judicial review brought by international doctors who want the exam declared unlawful, and has sparked a row after it called a version of the research conducted by an independent expert into the pass rates ‘misleading’.
Dr Kasaraneni said: ‘Significant questions still remain unanswered though, especially around not being able to exclude subjective bias in the marking of the CSA.’
‘As such, BMA representatives will meet the authors to discuss this and other issues raised in the report and consideration will given to the broader issue of the relative performance of trainees in examinations across the Royal Colleges.’
The final version of the GMC review was published yesterday, but another version of the research published by the BMJ made slightly differently worded conclusions, saying that ‘subjective bias due to racial discrimination’ in the clinical skills assessment may be a cause of higher failure rates for UK-born ethnic minority and international candidates taking the exam, a stance the RCGP strongly rejects.
But the author of the report, Professor Aneez Esmail, an expert in racism in the NHS, has accused the GMC and RCGP of misrepresenting his report’s findings and said evidence of racial bias must not be swept ‘under the carpet’.
Dr Ramesh Mehta, president of the British Association of Physicians of Indian Origin (BAPIO) – the organisation bringing the judical review – said it ‘welcomes and is relieved’ by the findings in the BMJ paper.
He added: ‘It will not be wise to ignore Esmails’ and Roberts’ concerns when they say “We cannot ascertain if the standardised patients (played by actors) behave differently in front of candidates from non-white ethnic groups. Nor can we confidently exclude bias from the examiners in the way that they assess non-white candidates”. It is very difficult to have confidence in an examination under these circumstances.’