Guest Opinion - The RCGP makes the case for the CSA

Many of you will be aware of the allegations of bias levelled at the RCGP following the disparity in pass rates by international medical graduates (IMGs) in the clinical component of the MRCGP exam.

We had a productive meeting with the British Association of Physicians of Indian Origin and the British International Doctors' Association. A follow-up is being arranged, to which we are also inviting the Committee of General Practice Education Directors and the BMA trainee committee.

The MRCGP exam is the cornerstone of the RCGP and is a key marker of quality. All trainees have had to pass it since 2007 in order to enter independent general practice.

The clinical skills assessment (CSA) tests the complex tasks that make up a consultation, namely the ability to apply and integrate clinical, professional and practical skills and communicate clearly and effectively with all patients.

It is a reliable exam that reflects the diversity of general practice and the diversity of our patient populations. Of the IMGs who pass the CSA first time, 40% score highly and it is important to mention that the applied knowledge test component of the MRCGP, which is anonymised and marked electronically, shows similar patterns of pass rates to the CSA.

The RCGP is one of only two of the royal medical colleges to monitor examiner and candidate ethnicity data. Researchers recently reviewed 52,000 cases and found no substantial effects of ethnicity.

As in any exam, a pass cannot be guaranteed just because a trainee has completed training and paid to take the exam. This is not about making money for the college but about ensuring that new GPs are as competent and prepared as they can be.

But a small number of IMGs are consistently failing the CSA and the RCGP is very aware of its duty to assist them by investigating the reasons.

Accusations of bias are not new but they seem to have reached new heights. We believe that with co-operation and collaboration, we can work through the issues together, ensuring the exam is fair, while ensuring that the MRCGP remains one of the most highly regarded medical exams in the UK and across the world.

  • Professor Gerada is a GP in London.

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