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In full: RCGP statement on BMJ paper and MRCGP review

RCGP response to BMJ paper on College exam

The RCGP have responded to research published in the BMJ.

RCGP Chair, Professor Clare Gerada, said: “We are shocked and bemused that on the very day that Professor Esmail’s official and independent GMC investigation report finds no evidence of discrimination, the same author is publishing a contradictory paper that misleadingly suggests we may be guilty of bias.

“We have always welcomed the official regulators’ investigation, and have complied fully with the requirements, providing all the relevant datasets and full access to our processes.

“In the official and independent GMC report, Professor Esmail finds 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’.

“He also says that: ‘our observations suggest that international medical graduates are treated exactly the same as British graduates’, going on to say: ‘lack of preparedness’ of international medical graduates ‘may be an explanation for the differences between the two groups’.

“We are hugely disappointed that the British Medical Journal has inexplicably decided to fast-track the peer review process for their article to be published on the very same day as the launch of the considered and comprehensive official regulators’ report, by the same author, with completely different conclusions based on the same evidence.

“The paper by Professor Esmail for the British Medical Journal appears to have been rushed through with undue haste – therefore calling into question the findings to which it comes.

“The independent regulators’ investigation by Professor Esmail took a full-six months to complete, the peer review for this paper has been rushed through in a matter of weeks – meaning that no one can have any confidence in the alleged findings. The process undertaken calls into question whether the reviewers had time to fully consider the findings of the official GMC report. This makes a mockery of the whole process.

“At no point were we asked for permission to use our data in order to publish a rushed and inaccurate paper on the very same day as the official regulators’ report, which contradicts its findings.”

She added: “The RCGP takes equality and diversity issues extremely seriously and strongly refutes any allegations that the MRCGP exam is discriminatory in any way – as is borne out by the official GMC report.

“It is our job to ensure that, through a fair process, the only the doctors who qualify as GPs meet the requisite standards for ensuring safe patient care. That is what the public expects of us, and that is what we deliver.”

Click here to read the RCGP statement on BMJ paper

RCGP response to the Independent Review of the Clinical Skills Assessment of the MRCGP examination

RCGP responds to Independent Review of MRCGP exam saying there is no evidence of racial discrimination and all International Medical Graduates are assessed equally to graduates from the UK

The RCGP welcomes this independent report and its key findings which show there is no evidence of subjective bias due to racial discrimination and that IMGs are assessed in exactly the same way as those from the UK.

It also finds that lack of preparedness of International Medical Graduates may be an explanation for the differences in pass rate, but that the method of assessment is not. The CSA examination and marking are based on internationally recognised methods.

The RCGP is committed to equality and diversity and has always strongly refuted allegations of discrimination in the MRCGP, subjective or otherwise. All of our assessment procedures are designed with fairness in mind but also to ensure safe care for patients, and we are always looking to enhance and improve our processes.

UK medical graduates have more exposure and training in general practice, both through medical school training and the foundation programme, than most International Medical Graduates whose home countries might not have health systems as dominated by primary care as the NHS is in the UK.

In noting the recommendations, we recognise many of the issues raised - particularly around the diversity of MRCGP examiners and role players, the mix of cases used in CSA exams and candidate feedback - and have been working hard to address these for some time.

For the past three years we have proactively approached doctors with primary medical qualifications obtained outside the UK and those from Deaneries currently under-represented on the panel of examiners to apply for examiner roles.

The ethnic mix of those role-players trained for the CSA is now broadly similar to the ethnic composition of the population of the United Kingdom and the RCGP is also reviewing the ways in which it can improve the feedback provided to candidates. We have already consulted with experts in this area, conducted an online survey amongst GP trainees, and are arranging a focus group with International Medical Graduates who have recently sat the examination.

Next week, a paper will be published in the British Journal of General Practice which looks at candidate and examiner gender and ethnicity in the MRCGP and finds no bias.

The College has co-operated fully with the GMC and Professor Esmail throughout the independent review and notes that the findings reflect similar disparities in other medical specialties.

Click here to read the RCGP response to the MRCGP review