I am indebted to GPOnline magazine for printing my full response to the CSA book controversy. If readers read the entire chapter instead of a passage taken out of context from an Amazon book preview, they would have read the start of the chapter discussing examples of how the world may perceive us (ie negative subjective bias) with ways to neutralise or turn into a positive and the end of the chapter discussing how my advice was just to change your image for one assessment and not who you are. The 'camp' category passage is not my bias nor that of the Royal College, but of how elements of society may still regard homosexuality in Great Britain and indeed the presence of homophobia in healthcare has been acknowledged publicly recently by the RCGP Chair Clare Gerada. The example cited in the passage taken out of context is of a young gay male resit GP trainee facing his 3rd exam attempt and was just an illustration how society may even perceive sexual orientation as a negative bias and therefore by neutralising any overt distractions, the doctor stands a fairer and better chance at passing a subjective exam in which he encounters 13 random actor patients and 13 random examiners, as he sits in his consulting room waiting for each actor patient to arrive accompanied by one examiner. He has 10 minutes to discover what the actor patient's concern or problem is and manage and repeats this for the next 12 strangers who will be knocking on his door. It is always the right of a GP trainee to complain to the Chief Examiner or Invigilator if he or she felt bias had affected their performance or marks, and I have raised the suggestion to the Chief Examiner that all 39 examining rooms have video cameras installed to record these simulated surgeries in the CSA exam to ensure candidates may provide evidence if they feel they have been discriminated or disadvantaged and have also suggested there be 2 examiners in each room, ie one marking and one shadow examiner as is the case for exams conducted by the other Royal Colleges, as another means of reducing observer bias. I am sorry there has been so much media attention over this. All I ask is that you actually read the entire chapter before passing judgement. Just as I advise GP candidates to neutralise their image so that they are not pre-judged before they have had a chance to demonstrate their communication and clinical skills in CSA, I ask that the world does not pre-judge me until you have read the entire chapter and not focus on a passage in the middle, taken out of context.
RCGP council member defends book that sparked investigation
An RCGP council member has defended a controversial book designed to help students pass MRCGP exams.
Earlier this week it was revealed that RCGP council member Dr Una Coales was being investigated by the college over a book advising MRCGP candidates on how to 'neutralise bias' from the college's examiners. The college also distanced itself from the book.
In a response to the investigation, Dr Coales defended her advice. She said: ‘The bottom line is that however hard you try, and the RCGP tries very hard, you cannot ever be sure that you have eliminated subjective bias entirely. So what is the candidate to do?'
Dr Coales said that some of the examples she used in her book to demonstrate pitfalls faced by students, such as acting ‘overtly gay’, were ‘over-emphasised, simplistic and perhaps brutal’.
But she went on to explain the reasons behind using such examples: ‘This is deliberate as many candidates are in denial either about how they themselves come across or, at least in my opinion, of the importance of giving consideration to these issues.'
Little did I know at the time, that racism in medicine or in particular, institutional NHS racism was being exposed publicly. In 1999, Dr Sam Everington, a GP and barrister, had researched and published on applicant selection bias by medical schools. In an interview with BBC news in 1999, he said,’ “This is institutionalised racism in the NHS - the deans have taken it to a new art form."
In a 1999 BMJ article 'Tackling Institutional Racism', Professor Joe Collier, blew the whistle and notified the Commission for Racial Equality about computer software being used in the student admissions process at a leading London teaching hospital/medical school that discriminated against ethnic minority candidates. This programme gave a lowered computer generated score for candidates with non-Caucasian names. As a NHS whistleblower, instead of being applauded for his bravery and courage, he was 'vilified and ostracised'.