Monday, 17 June 2013

BAPIO awaits Judicial Review permission over RCGP CSA while more minority GP trainees are put on SSRIs for depression

'In 2003, the then Prime Minister promised:
In ten years' time ethnic minority groups should no longer face disproportionate barriers to accessing and realising opportunities for achievement in the labour market
CSA GP trainees in tears
As GPs we listen to the patient's narrative and put the presenting complaint in the context of their home, work and social/financial circumstances. As a GP educator, I have received many GP trainee narratives of CSA. What do we do as doctors when we hear all this suffering over the RCGP CSA (Clinical Skills Assessment) GP actor exit exam?
BAPIO (British Association of Phyisicians of Indian Origin) took action once GP trainees contacted them by phone, by email and in person. BAPIO leaders, consultant paediatricians, conducted home visits and met with these Indian GP trainees and their grief-stricken families. It is not only Indian doctors who are failing CSA in large numbers, but white Eastern European IMGs (International Medical Graduates), Chinese and Black IMG doctors as well as a number of Indian, Chinese and Black UK graduates. After the CSA exam bar was raised from September 2010, why did the pass rate for white UK graduates go up and the pass rate for nonwhite UK and IMG graduates go down? What is happening behind the closed doors of the CSA exam which forbids videotape evidence of the CSA stations for fair appeals?

Here are their narratives:

'Being a single mother of two in full time training, full time job, full time mum, financial situation, etc. all contributed to my depression...failing CSA by 4 marks made me lose my confidence. I passed AKT with 82%. I have currently finished my 3 year training and I have been given an extension. I have been waiting for the placement for nearly 3 months and been told will start at the end of X. I have struggled financially in the last few months with all the expenses, including paying for CSA (£1,525 per CSA attempt),' Female IMG NHS GP trainee, mother of 2, who has been unemployed for 3 months while awaiting a practice for extended GP training.
'I have been in tears since been told that I am out of training. It is so unfair and humiliating. Why are the RCGP not recording csa?? I wouldn't wish this humiliation on anyone. I still wouldn't like to do anything else but GP despite being released.' Male ethnic minority IMG NHS GP trainee who made this cry for help on public twitter.
'This is S, emailing you from Scotland. I did not pass this time (first attempt)....overcome by trauma and grief.' Asian ethnic minority IMG NHS GP trainee.
'I failed my CSA in May, I was very stressed on the day. My last attempt is in November.' Ethnic minority IMG male NHS GP trainee.
'I failed my 4th CSA attempt and in a desperate situation.' Asian male ethnic minority IMG NHS GP trainee.
'I'd like to share how I prepared for my last CSA. I was out of training and met an ST3 doctor during an A&E locum. We became friends and formed a group consisting of 4 people, 3 of us were asian males and one Sudanese lady. We practiced for around 3 hours 4-5 times a week for 6 weeks. My current job only consists of home visits. So I only carried out visits in the Home Counties during this time. I also went to the gym almost every day and cut down on my night meals. Within the space of 2 months, I went down from 83 kg to 71 kg. I also got a hair cut and slicked back my hair, I'm quite short and this gave me the illusion that I'm a bit taller. I bought a saville row suit from a shop in the north (substantially cheaper than London) for around £500. I also bought a thin tie from Zara, black shoes sensible ones from Clarks and a short sleeve shirt. I told myself this is purely a game and I had to win. I would have to say, and with the addition of prayer, all this was absolutely essential, in my opinion, for success.' Asian Male ethnic minority IMG NHS GP trainee, married with a wife, who borrowed £10,000 from his parents to sit the CSA exams in order to work for the NHS and passed his 6th CSA.
'Unfortunately, I have not been successful with my CSA exam (64/117).' Chinese male ethnic minority IMG NHS GP trainee.
'I am writing on behalf of my wife, Dr X, who failed the CSA exam two times and is desperate for help to pass November. She did her best but does not know what went wrong.' Ethnic husband of a married ethnic minority female IMG NHS GP trainee asks for help.
'I failed for the fourth time, but this time it is a hard goodbye to general practice and the CSA. Failing by 3 marks is one of the worst experiences I have ever had in my life.
One day I thought when I joined medicine, it would be a noble thing to do, a profession designed to help others and be devoted to their care. I never thought that I would find myself in this situation, depressed, frustrated, disappointed.
Six of my colleagues, IMGs, also failed, ironically that has helped me to come to terms with what has happend to me. I am still a doctor with CSA or without...I have realised that I have just wasted 4 years of my life. Speaking to my colleagues in the States and comparing the USA medical exam to the UK medical exam, the UK exams are valueless and do not serve the purpose of training.' Female ethnic minority IMG NHS GP trainee must say goodbye to general practice forever.

'My name is Dr X, ST3 and I failed CSA 2 times. Now I am waiting for an extension and my next attempt will be in November. I am really desperate for help.' Ethnic minority female IMG NHS GP trainee.

'I failed again and this was my last attempt. 3 other candidates failed their 4th attempts in the same deanery (West of Scotland) whom I know. Several others failed their 3rd attempts as well.' Indian ethnic minority West of Scotland Deanery NHS GP trainee.

'I have one more final attempt to do in November. What do I need to do? Please help me. Is there any light on the horizon with the new current meeting between the RCGP and GPC of BMA or Professor Ismail's review on CSA. I am confused and need some practical advice.' Asian male ethnic minority GP NHS trainee.

'I have become yet another victim of 'CSA'. I was failed again by 2 marks (twice in a row). I feel really disappointed and angry with the examiners. However, you can't appeal and your career is destroyed. I have now been released from training. I joined the first wave ET class action with BAPIO. I am in a lot of anguish and any help/guidance in these stressful ties wil be highly appreciated,' Asian male ethnic minority IMG NHS GP trainee.

'I am a British born British Graduate who has fallen short in 4 attempts of CSA. I appealed against my last exam and have been successful and been given the opportunity to sit the next exam for free.' British Asian male NHS GP trainee who passed his 5th attempt and was given a score of 95/117.

'I am very keen for help for my husband. This will be his third attempt.' Asian wife of an Asian male ethnic minority NHS GP trainee.

'I passed the AKT...But unfortunately I failed CSA by one mark. 74/75. I have one attempt left. Have you any suggestions as to the best way forward?' A female British Asian UK graduate faced her final attempt after repeated CSA fails.

'I am an IMG, taking my last and presumed 4th final attempt with a lot of stress and anxiety. My trainer is happy with my CSA skills but not able to sell this in the real CSA exam.' Indian ethnic minority male IMG NHS GP trainee, Surrey.

'I am taking my last attempt, I failed the last time by 3 points.' Female IMG NHS GP trainee.

'I have failed CSA three times and I have one more try left outside training.' IMG NHS GP trainee, West Sussex.

'I am on treatment and I find my tablets help me sleep..I have had an offer of a 5th attempt which I painfully accepted, that put me into an additional £1,500 debt.' Chinese male IMG NHS GP trainee who has now been expelled from GP training over multiple CSA fails. He underwent extensive NHS counselling and was put on SSRIs to cope with numerous expensive CSA exam fails.

'I am sorry, I could not make it this time,' a despondent Indian male IMG NHS GP trainee.

'I failed CSA by 2 marks. I am resitting. This is my 4th attempt. Please help me.' Asian male IMG NHS GP trainee.

'I am XX, one of those victims struggling to pass CSA,' an Indian female IMG NHS GP trainee.

'I have applied for CSA. My educational supervisor said: 'Be prepared to lose £1525,' A female NHS GP trainee.

'What with the cost of having to repeat the exam...I am already only on 50% salary.' A female Asian GP NHS trainee, training part-time due to having children, finds the cost of resitting the exam very high.

'Today is a depressing day, got unexpected fail in my CSA for the second time. I made accurate diagnoses in all the cases and there are no crosses in that section but there are crosses that I haven't listened to the patient. How can it be that someone does not listen and makes an accurate diagnosis? It is not logical.' Asian male IMG ethnic minority NHS GP trainee.

'When I was working as a registrar, I had no major issues conducting clinics and getting along with work, patients and colleagues. In fact, my educational supervisor, who was in charge of our group training for GP trainees, was confident of me passing the exam. My eportfolio was evidence for this; even with failing CSA, my educational supervisor passed me overall at the end of the registrar year. Before I sat the CSA, I had more than 6.5 years experience working in the NHS. If someone is having trouble with patient care and communication skills, it would be picked up during the registrar year fairly easily. In my deanery, no one of a certain skin colour had to go on extended training due to CSA failures; if you get the figures separately from each deanery as to who went on extended training due to CSA failures, you will see the pattern. I think this is happening somewhat subconsciously by the examiners. It is a dangerous game to play as this has ruined lives of hundreds of doctors every year who serve the NHS. Myself, I don't work in the NHS anymore. This exam ruined my career as well as my personal life.' Black NHS GP trainee.

'Unfortunately failed by 3 marks (got 70). It was my 3rd attempt and the best result that I have got, previously got 53 (1st) and 63 (2nd). There is an Iranian Medical Society in the UK (IMS) but their activities are usually limited. I am not sure if I can get much help in the short term from them,' Iranian ethnic minority IMG NHS  GP trainee facing 4th and final CSA.

'I am in a dilemma and am seeking some sincere advice after failing CSA second time during my extension period. The panel have said they will release me from training on X. They have said to resit CSA but this will probably be once I am outside of training. Should I appeal against this decision asking for further extension as when I first took CSA I took it in May and not Feb as this was advised by my trainer. At the time I thought it would be appropriate because I thought there would be two CSAs in Sept and November if I needed it but as you are aware this has not been the case. Technically I have 2 more attempts but I'm not sure if they will allow me 2 more attempts out of training. Please advise?' Asian male IMG NHS GP trainee.

'Unfortunately I did not pass CSA. I scored 68 with a pass mark set at 73. I was shocked at the result given the fact that I thought it had been a smooth exam. This was my fourth attempt at the CSA, and I have now joined the lost tribe of CSA unless divine intervention occurs,' Black NHS GP trainee.

'I unfortunately just missed out on passing my CSA,' Black NHS male GP trainee.

'I scored 65, pass mark of 72. Am even more upset as this was worse than the 1st where I scored 72 (pass mark 73). I now believe more about bias and very subjective marking. 1st time I was in the 3rd day and had a morning session. Now I was on the last Friday of the exam with an afternoon session. The examiners and actors all looked tired.' Black NHS GP trainee.

'Unfortunately I didn't pass again.' Black NHS GP trainee.

'How do I get the CSA videos of the exams which I sat recently from the RCGP? It is very crucial for me as I have my last and final attempt in X and my marks have still not improved despite attending CSA courses when I felt more confident and thought I had done much better. Even my supervisor is perplexed. My supervisor said he thinks that I have good skills to be a good GP and I make sensible management plans with patients etc. but why have I failed all my CSA exams...So I was thinking of getting the videos so I could go through them and look at what mistakes I might have done or said or did not say cuz I am extremely disappointed with my recent CSA exam results. Is it possible to get the videos from the RCGP?' A female IMG NHS GP trainee pleas in vain for videotapes that are not saved for fair CSA exam appeals or for GP trainers to review with trainees for insight before their career in general practice comes to an end.

'I didn't pass my second attempt. I scored 67 and the passing mark was 73...I don't understand this exam and why it is making our lives so miserable. This doesn't reflect reality as my patients like amd and give me direct and indirect good feedback. The system is so unfair and hope something can be done about it,' an Indian male IMG NHS GP trainee.

BAPIO responds with 'Let them know they are not alone,' challenges CSA asking for Judicial Review, awaits result of the permissory stage of JR application and continues to fundraise with support from NHS consultants.

NHS consultants have also responded to the GP trainees pleas for help and donated to the BAPIO CSA Judicial Review fund with payments via paypal. Their goal is to raise £100k and thus far have raised £39,500 from NHS doctors of all medical specialties.

Mr NP, NHS Consultant Breast Surgeon, Lincolnshire, 'I have made a contribution through Paypal. All the best.'

Indian NHS Dr SB, 'I had already made a contribution a few months ago and have donated more this morning. I feel compassion towards those affected by this.

Indian GP trainee, Dr ARM, 'I have transferred £250 towards the cause of this legal battle.'

NHS Indian GP, Kirby in Ashfield, 'I AM DONATING £1000 TODAY AND ALL DOCTORS SHOULD DONATE WHAT THEY CAN AS IT COULD EASILY HAVE BEEN ONE OF US. We always have to fight for our rights and I did when I was first refused a place on Trent GP training and I wrote and asked then a simple 'why?' and it triggered an investigation which agreed that the system had positive bias towards native doctors and it was changed. So change can be made. We have changed the notorious PLAB test. Let us all try together. Many thanks.'

British Pakistani Doctors association and Medic Law were granted an Employment Tribunal pre-hearing review October 30-31, 2013 to hear the issues for class action.