Hundreds of Asian, Chinese and Black ethnic minorities, predominantly male NHS GP trainees, often also fathers of young children, have been devastated by the CSA actor GP exit exam. Let not this one exam separate a father from the love of his family. Give him back his dignity and ability to provide for his family. Do not watch wives take their children away and leave the country. Do not separate a young child from her father. He wants to show his daughter how much he loves her but is unable to while he lives a constant psychological, financial and social nightmare, trying to pass the seemingly impossible CSA exam. He trained with real patients with real diseases. He did not train in medical school with actors faking illnesses. He does not know how to 'act' like a doctor treaing a faked disease, as all he knows is how to be a real doctor treating real medical conditions. Do not encourage masking the problem with SSRI antidepressants and anxiolytics. Please admit there is a problem and address the real problem as soon as possible. With each passing diet of this exam, more lives and families are shattered. The only difference in the photo depicted above to that of minority GP trainees is the colour of the father's skin.
2013 marks the 50th anniversary of Martin Luther King's speech 'I have a dream' whereby people are judged by the content of their character and not the colour of their skin.
Why not increase diversity among the predominantly white CSA examiners?
Why not increase diversity among the predominantly white CSA actors?
Why is there a difference in pass rates among GP specialty training Deaneries?
Why is there such a huge disparity in CSA exam pass rates between white (96%) and nonwhite GP trainees (66% black British, 36% Indian IMG, 25% chinese IMG) when the difference was negligible 5% when assessed with videos of real patients in real GP surgeries?
What is the solution?
Local UK graduates will have practiced role plays from day 1 of UK medical school. IMGs have only treated real patients with real diseases from day 1 of medical school overseas and throughout their many years of NHS service and are not exposed to role playing with actors faking illnesses until late into their UK GP training programme. This would then give IMGs an unfair disadvantage when sitting an actor roleplay CSA exam as an exit GP exam. Better to go back to video assessments (as was previously used as an exit GP exam by NHS Deaneries) with real patients and real diseases as both UK and IMG doctors will have treated real patients equally in the NHS.
I leave you with one story. A CSA role play actor was faking right shoulder pain for an Asian IMG GP trainee on my course. The trainee who had years of NHS experience in surgery and had MRCS seemed baffled by the patient's history and being asked to examine a normal shoulder. The actor tried his best to fake shoulder pain but the role play seemed disingenuous. He wasn't really in pain. So the actor stopped role play and said well actually my left shoulder does hurt and I have been waiting ages for a GP appointment. So we interrupted the role play and I asked the IMG to examine the shoulder with real pain and real pathology. The IMG confidently and swiftly examined the left shoulder, made and shared the diagnosis and sat with the actor to share the management plan. The actor's eyes welled up with tears. He looked around the room and got it. He understood why so many IMGs/BMEs were sitting around the room, having failed the CSA exam umpteen times, not because they were not good doctors but because they were not good actors, they could not pretend to examine or make a diagnosis in a healthy patient who was faking pain.