Two weeks notice served of Judicial Review, an application to the High Court challenging the RCGP CSA exam and the GMC, who subcontracted the RCGP to deliver the CSA.
The British Association of Physicians of Indian Origin, a charitable organisation who also include physicians of all ethnicities, has now served the Royal College of GPs and General Medical Council with a 'letter before action' of Judicial Review of the CSA (Clinical Skills Assessment) GP licensing exam, a tool which employs 13 actors and 13 examiners to role play 13 different artificial cases for each GP trainee. They have enlisted the legal services of barrister Karon Monaghan QC of Matrix Chambers. She has agreed to represent for the concomittant Employment Tribunal legal action on behalf of a class action of released GP trainees who failed to clear the human-marked subjective CSA actor exam which came into existence in October 2007.
Of note, is the fact that over 40,000 of the 60,000 working NHS GPs have never sat this CSA exam tool and are working satisfactorily. 30,000 NHS GPs do not have MRCGP, as they have either never sat the College exam or may never have passed the exam. Many GP trainees would like their 3.5 years' experiences of seeing over 2,000 real patients taken into account to remain as practicing GPs, as this was the rule prior to October 2007, when the MRCGP was not obligatory to work as a NHS GP.
Many GP trainees ask to submit videos of real consultations with real patients as an alternative and authentic tool and have consideration placed on passing all their regular checks and video submissions for their workplace-based assessments, rather than have 100% weight on a 3-hour expensive £1,525 exam sat under artificial conditions with a perception of reliance on 'acting', failure of which has been the chief reason for expulsion from GP training.
Surprisingly, the RCGP refuse to record the CSA licensing exam for GP trainees to rely on as evidence of possible discrimination at an exam appeal. The College reason is that 'video is not necessarily a good record of the consultation in CSA.' Yet video recording of patient consultations was accepted to award the old MRCGP exam to 10,000s of established and training GPs prior to 2007. Random video recording for independent assessment is used by the Irish College of General Practitioners for their MICGP licensing exam and video monitoring and recording is used by the US medical licensing exam boards.
Black and minority ethnic GP trainees ask 'what do I have to do to get 9/9 marks at a CSA station?', as an Asian international medical graduate receives 6/9 marks based on this CSA examiner marking sheet in which he has passed all 3 domains (data gathering and assessment skills, clinical management skills, and interpersonal skills to receive a global mark of Pass) yet only receives 6/9 marks towards his total marks from 13 CSA stations. Of note, he receives no 'x's in 16 performance criteria indicating he has nothing to improve. He faces his 4th and final CSA as one of the 13 CSA examiners on this day gave him a mark of 1/9 which tipped the balance to overall fail. IMG trainees ask how to protect themselves against an extreme hawk examiner who by giving 0-3/9 in 1 of the 13 stations can offset total marks to result in an overall fail.
Institutional Racism rife in the NHS
BAPIO continues to fund-raise for the imminent Judicial Review of the RCGP CSA exam and of GP training, while more GP trainees are prescribed anti-depressants and anti-anxiety medication to face the CSA actor exam.
I am absolutely certain that being clean shaven helped me to pass on my 3rd attempt. I feel very angry and embarrassed that I had to do what I did in order to pass an exam. What hurts the most is that my own integrity has been brought into question by friends, family and other mosque-goers. I think they feel that if I could compromise my faith for the sake of an exam then that calls into question my integrity as well. I also feel a personal moral dilemma, as a religious person I feel one day I will have to answer to my creator for compromising my faith.'
Sadly the MRCGP CSA statistics for 2011/12 continue to show a great disparity between UK graduates (based on ethnicity) and between UK and IMG graduates. http://www.rcgp.org.uk/gp-training-and-exams/mrcgp-exam-overview/mrcgp-annual-reports/~/media/Files/GP-training-and-exams/Annual%20reports/MRCGP%20Statistics%202011-12%20final%20121212.ashx.
News of the GP CSA exam reaches national UK media.