BMA raises concern over discrimination in RCGP exam
BMJ 2013; 346 doi: https://doi.org/10.1136/bmj.f290 (Published 15 January 2013) Cite this as: BMJ 2013;346:f290The BMA has written to the Royal College of General Practitioners to express concern over differences between UK and overseas candidates’ pass rates in the college’s membership examination.
The BMA is worried about differential pass rates in the exam’s clinical skills assessment (CSA) component. The chairman of the trainees subcommittee of the BMA’s General Practitioners Committee, Krishna Kasaraneni, said that he had been approached by association members who believed that the CSA discriminated against medical graduates who qualified outside the United Kingdom.
The subcommittee has suggested that CSA exams be video recorded so that the college could revisit and analyse the examination in cases where concerns were raised.
In 2010-11 the pass rate for the CSA element of the membership of the Royal College of General Practitioners examination (MRCGP) was considerably lower among doctors who studied medicine outside the UK than among UK graduates (37% versus 91%).1 This disparity in the pass rate was present in all the ethnic groups recorded. The pass rate at the first attempt among south Asian doctors was 37% for those who qualified abroad and 85% for those studied who in the UK.
The CSA component can be taken only in the final year of training and is designed to assess doctors’ data gathering, clinical management, and interpersonal skills.
Kasaraneni said that doctors whose first language was not English may have struggled with some of the “sociolinguistic norms” in the exam, such as the use of nuance, humour, and understatement. Another problem may be that GP trainers are not skilled in or comfortable with dealing with issues relating to linguistic or cultural differences among international medical graduates, he added. As a result, some overseas medical graduates were not adequately prepared for this aspect of the exam and unexpectedly fail, he said.
The British Association of Physicians of Indian Origin (BAPIO) has been campaigning to highlight the higher CSA failure rate among overseas medical graduates. It said that doctors who failed the exam four times were not able to complete GP training and to practise independently. This was the case even if they had progressed satisfactorily through the other elements of the three year training course, it said.
BAPIO has called on the royal college to review the exam and put in place remedial mechanisms to support doctors who may be adversely affected by the current system. It has raised more than £30 000 to fund a judicial review should the college not resolve the system satisfactorily.
Representatives of the college met the BAPIO and the British International Doctors Association in December to discuss the differential pass rates in the MRCGP CSA exam. The college acknowledged the differential pass rates in the CSA but stated that overseas medical graduates lost marks in the same areas as doctors who qualified in the UK but to a greater extent.2
The college has reviewed 52 000 cases and found no substantial effects of sex or ethnicity on interactions between examiners and candidates. It has also commissioned a detailed analysis of 40 consultations that will assess the sociolinguistic aspects of the CSA.