GMC defends MRCGP exam as row erupts over report findings

The GMC has launched a strong defence of the MRCGP exam after an independent report found the method of assessment is 'not a reason' for significant differences in pass rates between UK and international graduates.

GMC chief executive Niall Dickson: backed report on MRCGP
GMC chief executive Niall Dickson: backed report on MRCGP

The delayed Independent Review of the Membership of the RCGP (MRCGP) was commissioned by the GMC, which regulates medical education and training, and led by Professor Aneez Esmail - a University of Manchester professor of general practice and expert on racism in the medical profession.

A final version of the report was published today after a leaked draft version emerged earlier this month.

Responding to the report, GMC chief executive Niall Dickson said: ‘The report by Professor Aneez Esmail found that while there are significant differences in pass rates between different groups of doctors, the way they are assessed in the CSA is not the cause of those differences.

‘In particular Professor Esmail found that the pass rates for doctors sitting the computer marked applied knowledge test mirrored their performance in the CSA exam.

‘His report draws a clear conclusion: "the method of assessment is not a reason for the differential outcomes" in the pass rates.

‘We welcome his conclusions, which we hope will both provide some assurance and help find better ways to support doctors undertaking GP training.'

But the RCGP has reacted angrily to the publication of research in the BMJ based on Professor Esmail's research. The paper was published on Friday to coincide with the GMC-commissioned report.

Both the report for the GMC and the BMJ paper say it is not possible to rule out subjective bias in part of the MRCGP assessment, but different wording in the two versions has provoked an angry response from the RCGP.

Black and ethnic minority (BME) international medical graduates are nearly fifteen times more likely to fail the CSA exam at their first attempt, and BME UK graduates are nearly four times more likely to fail, than their white UK colleagues, the report for the GMC said. These figures are also reported in the BMJ paper.

The GMC-commissioned report reads: ‘It is also our view that the method of assessment is not a reason for the differential outcomes that we have described.'

The report continues: 'The nature of the examination is such that it is open to subjective bias. We cannot ascertain if the standardised patients (played by actors) behave differently in front of candidates from non-white ethnic groups.

'Nor can we confidently exclude bias from the examiners in the way that they assess non-white candidates. However, having observed (by Professor Aneez Esmail) the examination and read the background documentation, it is clear to us that the RCGP is aware of these potential biases and takes steps to mitigate them.’

The BMJ paper, meanwhile, says: 'Subjective bias due to racial discrimination in the clinical skills assessment may be a cause of failure for UK trained candidates and international medical graduates. The difference between British black and minority ethnic candidates and British white candidates in the pass rates of the clinical skills assessment, despite controlling for prior attainment, suggests that subjective bias could also be a factor.'

The RCGP said it 'takes equality and diversity issues extremely seriously and strongly refutes any allegations that the MRCGP exam is discriminatory in any way – as is borne out by the official GMC report'.

RCGP chairwoman Professor Clare Gerada said: 'We are shocked and bemused that on the very day that Professor Esmail’s official and independent GMC investigation report finds no evidence of discrimination, the same author is publishing a contradictory paper that misleadingly suggests we may be guilty of bias.

'In the official and independent GMC report, Professor Esmail finds that: "the method of [the RCGP] examination is not a reason for the differential outcomes that…have been described. The CSA examination is based on a well established pedagogy which is internationally recognised and used widely in postgraduate examinations".

'He also says that: "our observations suggest that international medical graduates are treated exactly the same as British graduates", going on to say: "lack of preparedness" of international medical graduates "may be an explanation for the differences between the two groups".'

Professor Gerada added: 'It is our job to ensure that, through a fair process, the only the doctors who qualify as GPs meet the requisite standards for ensuring safe patient care. That is what the public expects of us, and that is what we deliver.

She said the BMJ paper had been 'rushed through with undue haste', calling into question its findings.

Dr Fiona Godlee, BMJ Editor-in-Chief said: 'The paper published today in the BMJ underwent full peer review including full statistical review. It was fast tracked, which is a standard procedure at the BMJ and elsewhere, in order to be published at the same time as the GMC report.

'We stand by its findings and look forward to further discussion of the implications for post-graduate training and workforce planning.'

The British Association of Physicians of Indian Origin has been granted a judicial review into the fairness of the clinical skills assessment element of the MRCGP exam, which it hopes will go ahead later this year.

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