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RCGP study finds CSA exam is fair

Exclusive: The RCGP has revealed that a major study into the CSA exams  found ‘no substantial effects of gender or ethnicity on examiner/candidate interactions’ in an effort to ‘set the record straight’ on accusations that the exam was biased against international medical graduates.  

Dr Ben Brown, chair of the Associates in Training Committee and RCGP chair Dr Clare Gerada sent a letter to all associates in training today (Friday 21 December). It said that a review of 52,000 cases, carried it out in conjunction with King’s College, had shown the exam was fair and that there were ‘no substantial effects of gender or ethnicity on examiner/candidate interactions’.

The RCGP said the full results of the survey would be released in the new year. It also said the RCGP will undertake a survey of candidates’ views of the exam in February.

Figures from 2010/11 show that the failure rate for international graduates taking the CSA component of the MRCGP was 63.2%, compared with 9.4% of UK graduates.

The British Association of Physicians of Indian Origin has said it is considering a possible judicial review if talks with the RCGP do not provide a resolution.

Dr Brown and Dr Gerada wrote: ‘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.’

‘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.’

Both doctors sat mock CSAs in recent days, the letter said, and they were ‘extremely impressed by the high standards’ of the examiners and actors and were ‘reassured that the process was professional, fair and well organised’, they said.

They wrote: ‘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.’


The RCGP is one of only two royal colleges that routinely monitors candidate and examiner ethnicity, they said.

They added: ‘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.’

‘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.’

The letter added: ‘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.’