Are Indian doctors in UK shut out by biased exams?

A group representing Indian-origin doctors is taking legal action against the British medical establishment, claiming Indian and other foreign doctors are being judged unfairly in tests of their patient-doctor communication skills.

It comes down to one particular test that all international medical graduates (IMGs) have to pass in order to practice as a
General Practitioner in Britain. And it could all boil down to their English-language skills.

This test is known as the Clinical Skills Assessment (CSA), which is a component of the MRCGP exam.

The test is intended to mimic practice as a GP and test a trainee’s clinical skills. Each candidate is required to see a number of patients, each of whom is an actor role-playing to present a clinical case.

The group that is bringing the legal case, the British Association of Physicians of Indian Origin (BAPIO), argues that “opportunity for bias” arises at this face-to-face assessment that trainees have to undergo during the mock consultation.

“It appears that during the exam a physician’s intellectual ability is judged on the basis of how well he/she speaks native English,” says BAPIO.

The group quotes official figures to support its case. In 2011-12, 65.3% of international graduates failed their first attempt at the CSA test, compared with 9.9% of UK graduates.

The failure figures for 2010-11 were 59.2% for IMGs and 8.2% for UK graduates. In 2008, 43% of IMGs failed the CSA compared with 8.3% of UK graduates.

These are, by any standards, pretty shocking figures.

“There is a significant difference in pass rates which cannot be explained by a lack of any knowledge, skill or competency,” says BAPIO.

Further, in order to qualify as a trainee GP, these graduates will already have passed a PLAB (Professional and Linguistic Assessment Board) exam. All non-Europeans who want to work as doctor in Britain have to pass PLAB.

PLAB is a rigorous exam that tests not only a candidate’s professional ability but also their English-languages skills.

Indians who have sat the PLAB exam often complain how they are presented with patients with thick British regional accents, which many find examinees have found impossible to understand.

To reach the CAS stage, each trainee GP would also have seen 3,000 patients – without any complaints. They have would have had positive comments from their trainers and passed theory tests.

The conclusion that BAPIO draws is that that the MRCGP exam is “flawed and discriminates against international GP trainees.”

BAPIO’s seeks a judicial review of the way the MRCGP exams are conducted by the Royal College of General Practitioners (RCGP) and the General Medical Council (GMC).

The RCGP dismisses out of hand any possibility of bias creeping into the MRCGP exams.

“…The RCGP takes any suggestion of bias, subconscious or otherwise extremely seriously, and this is therefore an issue on which we have done a considerable amount of research,” it says. There is no evidence, it adds, that examiners “substantially favoured their own gender or ethnic group.”

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