Regulator starts review of MRCGP pass rate amid claims of bias

The General Medical Council has begun an independent review of the pass rates for membership of the Royal College of General Practitioners (MRCGP) examinations, amid concerns that doctors who trained overseas and those of ethnic minority origin are more likely to fail.

Earlier this month the British Association of Physicians of Indian Origin started legal proceedings against the RCGP and the GMC, after talks with the college had failed to resolve its concerns, the association said.

It alleges that the MRCGP exam unlawfully discriminates against international GP trainees, on the grounds that the significant difference in pass rates cannot be explained by a lack of knowledge, skill, or competency.

RCGP figures show that two thirds of international medical graduates (63.2%) failed their first attempt at the clinical skills assessment (CSA) component of the MRCGP exam in 2011-12, compared with one in 10 (9.4%) graduates who trained in the UK, the association says.

Its lawyers argue that opportunity for bias arises in the face to face assessment that trainees undergo during the mock consultation with actors, when a trainee’s intellectual ability would seem to be judged on how well he or she speaks native English.

The association is also pursuing Employment Tribunal action against the RCGP on behalf of 300 GP trainees who have failed the CSA and been removed from training since 2010.

Ramesh Mehta, the association’s president, said, “These doctors have had extensive interaction over a period of many years with their trainers and patients without significant concerns. For them to be judged to be so grossly incompetent in a short exit exam either reflects poorly on years of training, which is unlikely, or it is because the exit exam is flawed.”

Niall Dickson, chief executive of the GMC, said, “This is a critical examination for doctors wishing to become GPs, and it is vital that doctors, patients, and employers have confidence that it is both fair and robust. Where serious questions have been raised, as they have in this case, it is right that we should look at them.”

Aneez Esmail, professor of general practice at the University of Manchester, will lead the GMC’s data review, which will focus on all the applied knowledge test and CSA sittings from October 2010 to December 2012. The findings will be submitted to the GMC by the end of June 2013, and a report is expected to be published later in the summer.

Esmail warned that it was unlikely that definitive answers would be found in such a short time but hoped “to identify the key areas where there may be unanswered questions and offer suggestions as to further research that might be required.”

The RCGP’s chairwoman, Clare Gerada, said that the college planned to undertake further, more detailed, research into the exam later in the year. The college has met twice with the British Association of Physicians of Indian Origin and the British International Doctors’ Association to discuss differential pass rates in the MRCGP exam.

The RCGP said in a statement, “We agreed to move forward together to clarify accurate numbers of doctors unable to obtain their certificate of completion of training (CCT) because of CSA failure.

“Despite the productive meeting, BAPIO [the British Association of Physicians of Indian Origin] explained that they will be proceeding with their legal action.”