Letters Discrimination in the MRCGP exam

We need to investigate whether racial discrimination explains differences in MRCGP exam results

BMJ 2013; 347 doi: http://dx.doi.org/10.1136/bmj.f6479 (Published 29 October 2013) Cite this as: BMJ 2013;347:f6479
  1. Raj S Bhopal, Bruce and John Usher professor of public health1
  1. 1Edinburgh Ethnicity and Health Research Group, Centre for Population Health Sciences, University of Edinburgh, Edinburgh EH8 9AG, UK
  1. Raj.Bhopal{at}ed.ac.uk

When differences in health status, healthcare, or health professionals’ performance are found for minority populations, the most uncomfortable, and arguably most important, interpretation is that the cause is racial discrimination.1 Considerations of racial discrimination in medicine, whether for staff or patients, are hardly new,2 but it is good to have a fresh opportunity to examine the matter.3

Esmail and Roberts found population subgroup differences in failure of the membership of the Royal College of General Practitioners exams.4 Several findings give insights that might help interpret the data.

Firstly, in all groups more men fail than women. The inequalities transcend race and ethnicity. This raises the spectre of sexual discrimination against men.

Secondly, because more white international and European economic area medical graduates fail than UK black and minority ethnic group graduates, the inequalities are not merely crude racial prejudice, based on physical features such as colour.

Thirdly, UK graduates in the black and ethnic minority group do worse on the machine marked applied knowledge test. Esmail and Roberts point out that the interpretation of this is complex. Clearly, the results relating to the clinical examination are equally complex.

Fourthly, on resitting the exam, UK ethnic minority graduates do as well as white UK graduates, although not in further attempts. If racial discrimination was the main cause of the initial failure, this ought to be reflected in the second sitting.

Esmail and Roberts proposed a hypothesis of racial discrimination. The medical profession would do well to prioritise this explanation as the first one to be considered and studied in depth.


Cite this as: BMJ 2013;347:f6479