The British Association of Physicians of Indian Origin and the British Pakistani Doctors Association say NO to 'unconscious bias' in the RCGP actor CSA exam that has decimated the lives and careers of over 300 Asian, black and chinese male GP trainees.
- say NO to the actor CSA (clinical skills assessment) exam with no shadow examiners, no controls for extreme hawk examiners, no testing for 'unconscious bias', no video monitoring for appeals, no video module alternative to the CSA;
- say NO to borrowing £1525 to cover the actor CSA exam fee x 4-5 times from your elderly parents or maxing out your credit cards;
- say NO to SSRI antidepressants and marital breakups;
- say NO to beta blockers and sedatives;
- say NO to despair;
- say NO to praying and weeping as you and your wife await your CSA results;
- say NO to depriving your family of Christmas presents to cover exam fees yet again;
- say NO to spending only 5 minutes with your wife each day as you are consumed with depression and stress over the CSA exam as an Asian male doctor;
- say NO to passing and then being failed on WPBA (work-placed based assessment eportfolio);
- say NO to passing and then being refused CCST as you passed a few days or weeks outside of your GP training extension;
- say NO to failing a 5th CSA by 1 mark;
- say NO to GMC referrals for multiple fails of an actor CSA exam;
- say NO to only receiving 82 marks out of 117 yet passing all 13 CSA stations with no crosses for improvement;
- say NO to watching all the IMGs or ethnic/black GP trainees in your GP VTS (vocational training scheme) fail the CSA exam, thus creating an unintentional apartheid among GP trainees who once nearly all passed the Deanery summative assessment (video and MCQ modules) prior to October 2007;
say NO to 612 ethnic (UK and IMG) GP trainees failing the actor CSA exam first-time between 2011 and 2012;
In 2007, Harvard psychologists Banaji and Greenwald educated the world about a new phenomenon called 'unconscious bias' and how to test for this.
- say NO to an exam using healthy actors who allegedly help or hinder GP trainees, with no clinical exam findings as they are faking illnesses;
- say NO to an exam module in which an examiner fans herself with an examination card to prompt a female GP trainee and when confronted says it is due to the heat in 4 degree weather;
- say NO to CSA in which ethnic GP trainees report the examiner and actors allegedly smile at each other when an IMG mispronounces a word or makes a mistake and laugh as they exit;
- say NO to CSA in which ethnic GP trainees report the actors allegedly forget their lines, over-act or are overly aggressive to ethnic and black GP trainees and the RCGP refuses to videomonitor this behaviour for appeals;
- say NO to an exam in which ethnic GP trainees report the actor sits in silence, avoids eye contact with an ethnic or black GP trainee and refuses to answer his questions until the last minute of the exam or hides his or her underlying concern from an IMG but readily shares with a UK graduate, who has a 98% CSA pass rate, if also female;
- say NO to an exam in which GP trainees report the examiner prompts UK graduates with 'you will be assessed on your prescription,' 'is there anything else you would like to examine?' and readily gives out exam findings yet the ethnic GP trainee has to ask for the blood pressure reading twice from the examiner and is not interrupted by the examiner when performing a full examination on a healthy actor, awaiting an announcement of the exam findings;
- say NO to an exam in which GP trainees report and lodge complaints that the actors are yawning and tired and are not sure if they are acting hypothyroid?
- say NO to an exam that asked a male Asian GP trainee to sit CSA without a clock to keep to time so he was unable to time-manage, and when he asked for one after a couple of exam stations without a clock, was provided a small clock while others had access to a standard CSA room desk clock. He was then failed in CSA.
- say NO to an exam in which a male Asian GP trainee alerted the marshall on the day that the actor was biased and gave reasons why and asked that a video of this actor be kept for appeals, only to be told it would not affect his results; he got the maximum number of crosses for this station and failed the exam with no access to a video for evidence.
- say NO to an exam which was conducted while construction was going on in the building causing noise disruption.
- say NO to an exam which was conducted in cold CSA rooms in winter. Candidates complained and were provided with noisy fan heaters which made listening to the actors difficult and necessitated asking the actor or examiner to repeat himself. Some then reported being failed on 'listening skills.'
- say NO to an exam which has a 66% pass rate for Irish GP trainees and a 91% pass rate for UK GP trainees.
Let their voices be heard this Good Friday...some of the 100s of emails BAPIO, BPDF and I have received from CSA victims...the lambs will not be silenced.
To say I'm devastated is an understatement, as I left a pharmacy career to pursue medicine with the ultimate aim of becoming a GP.
My origins are Nigerian, but I was born in Hackney, East London, my hopes was to go & work in the inner city where I feel most at home.
I am well & truly lost & would very much value any advice you could offer. Can I sit the exam again?
I have read your comments on the subjective bias of the exam & I'm in total agreement, speaking from personal experience. Unnecessarily aggressive actors etc etc.
Please, if there is any advice you can offer, I would be extremely grateful.
3 other candidates failed in their 4th attempt in the same deanery (West of Scotland) whom I know. Several others failed in their 3rd attempt as well.
I just thought to keep you informed about the CSA failures.
A kind London CSA examiner/invigilator arranged for him to practice 'acting' with CSA actors in her surgery to no avail. The CSA examiners are 86% white British and the actor mix is predominantly white British.
I'm writing to ask some advice please as I want to challenge this. What are my options?
Can I ask college for a case-by-case feedback (in each domain)? Also would I be able to ask the video of my CSA exam?
It's frustrating that I failed, whereas all my six colleagues who are White British passed. Although we all had CSA on different days, I know of some serious mistakes made by a couple of them (giving COC pill to women who had migraine with aura & almost prescribing Sildenafil to someone on nitrates), they still passed!!
I'm aware that I can't complain about someone else's performance. I feel frustrated and thinking to give up GP altogether. I don't want to get humiliated like this again. It feels like a long tunnel with no light at the end.
My trainer who's white British doesn't think there is any problem in my consultations. I've had good feedback from patients.
Your valuable advice is much appreciated. Thanking you in anticipation.'
'I am in a position now (a/w CSA result from 4th attempt, out of training, hugely in debt)..Unbelievable..failed CSA shortfall of 1 number 73/74. It was my last attempt. What shall I do? Shall I appeal? Please suggest.'
'I attended ARCP panel today along with other trainees in similar situation. Failed my 3rd CSA attempt in November '12 (by 3 marks). I was told today, my training will stop on 31/1/12 but will be able to appear for my last attempt on 1st February (got the date today).
I was told I can appeal against this decision but they recommend not to do so because there is no chance to win!
Current plan -
1) to appear for CSA for the last time
2) If I pass, move to Australia
3) If don't pass - move to Australia as Non VR GP
Please advise me.'
'appeared for CSA this February 2013 for the first time and I failed. Everyone in my surgery and my trainer were shocked. I have passed three royal college exams in England. I have been told I have good communication skills and clinical skills.
In my Wessex deanery all the whites who ever appeared passed! Surprise! Surprise! How can that be possible? Not even one of them failed?!
One of them didn't even clear the first part of the exam (AKT) - which gives you essential knowledge to pass!'
'In one of the East of England VTS schemes, 14 trainees appeared for CSA, only two trainees passed, one local white doctor - the only local doctor in the scheme and one IMG in her first attempt while the rest of the 12 failed. They were all IMGs.'
'North Lincolnshire area news (I think Sheffield deanery) 15 took the exam, 5 passed. One local white of the 15 passed. One first time pass for IMG female (4 crosses 84/117).'
'Yorkshire Deanery North Lincs VTS had 11 IMG GP trainees out of 12. CSA failed 8 IMGs.'
'Dewsbury/Wakefield/Pontefract GP VTS scheme Yorkshire + Humber Deanery has 3 fails, all 3 IMGs! Highest score of 105 goes to white male!'
'NW Deanery (confirmed)
2011. 29 total given outcome 4 released from GP training (20 due to CSA failure).
2012. 43 total given outcome 4 released from GP training (30 due to CSA). 25 have been referred to the GMC.'
One local first attempt. Pass/Male
One IMG second attempt. Pass/Female
one IMG first attempt Pass/Female
One IMG third attempt Fail/Male
One IMG second attempt Fail/ Male
Two IMGs first attempt. Fail/one male and one female'