Tuesday, 11 December 2012

RCGP faces legal threat over international GP trainee failure rates

'Never, never be afraid to do what's right, especially if the well-being of a person or animal is at stake. Society's punishments are small compared to the wounds we inflict on our soul when we look the other way.' Martin Luther King.


Pulse GP magazine printed an article entitled 'RCGP faces legal threat over international GP trainee failure rate' on 13 November 2012. Since, it has become the most commented and most popular online Pulse article with over 200 GP reader comments including a supportive one from a British GP trainer Dr Steven Taylor who has trained IMG GP trainees himself. This was followed by an article in the hard copy of Pulse entitled 'The RCGP must answer CSA concerns' written by GP trainer Dr Shaba Nabi which also received numerous comments.

Both BAPIO (British Association of Physicians of Indian Origin) and BIDA (British International Doctors Association) were inundated with complaints from international medical graduates of the high failure rate for the MRCGP CSA (Clinical Skills Assessment) exit licensing exam for General Practitioners and the ensuing expulsion of up to 300 GP trainees (according to BIDA) from specialty training since the change to CSA marking from September 2010's exam diet. Unlike other Royal College membership exams, whereby a surgeon can continue to work as a staff grade even if he fails his exit exam and apply for CCT when he eventually passes, there is no way back once a GP trainee fails the CSA four times, and his or her Deanery extension period has expired, if he or she has started GP training after August 2010 when a trainee could have unlimited exam attempts.
As an independent course provider, I recognised that there is a strong emphasis on the psychosocial element of the GP consultation as well as communication skills (nonverbal and verbal communication, paralinguistics, etc.) in CSA. Perhaps the Deaneries could focus on providing their GP trainees targeted education in communication skills from the ST1 year and offer remedial training in these specific areas for 'doctors in difficulty.'
However clearly there is something else present if local UK BME (black and minority ethnic) doctors are also failing CSA (96% pass rate for white UK British vs 66% pass rate for Black UK British according to the RCGP annual 2010-2011 exam report http://www.rcgp.org.uk/gp-training-and-exams/mrcgp-exam-overview/mrcgp-annual-reports.aspx). And this is why I had hoped the RCGP would test for exam bias. The Harvard Implicit Association Test is one such well-known and recognised form of testing for bias. Even UK SE Asians who have  the highest pass rate in the written (AKT- applied knowledge test with 200 multiple choice questions) of 95.7% see a significant drop in pass rate to 77% when sitting the CSA exam, an exam conducted in the presence of CSA actors and examiners (one actor and one examiner for 10 minutes per room).


Are women better GPs?

Another interesting observation in the CSA exit exam is the total pass rates for male and female GP trainees. Men have a 20% lower total pass rate than female GPs, 66% vs 86%! UK male GPs have a 85% pass rate compared with UK female GPs with a 95% pass rate. Are we slowly replacing male GPs with female GPs?

BAPIO and BIDA have decided to take further action over CSA. They have set up a BAPIO fund. Donate to BAPIO Lloyd Bank sort code 30-90-66 Account number 00066608. Reference CSA.

I am reminded of Jane Elliott, a teacher and human rights activist who on the eve of Martin Luther King's death demonstrated the 'blue eyes, brown eyes' experiment and how discrimination affects performance. https://www.youtube.com/watch?feature=player_embedded&v=8bWlTZZN3DY I sincerely hope that this is not how Asian IMGs are made to feel facing an expensive CSA exam (£1,525 per sitting) with a pass rate of 36% vs a white British CSA pass rate of 96%.