Ethnic minority trainee GPs are suffering from racial discrimination, claims Manchester uni study

By Judith Hawkins

Racial discrimination against ethnic minority GP candidates was uncovered in a study published yesterday by The University of Manchester.

British black and ethnic minority graduates were more likely than their white colleagues to fail the clinical skills assessment exam, which doctors must pass in order to practise as a GP.

During the clinical skills assessment (CSA) potential GPs are tested in a replica NHS surgery, with patients played by actors.

These trained role players follow a script with the patient’s medical history, psychosocial background and personality, to which the candidates respond while an examiner observes and marks.

After analysing data for 5,095 candidates the researchers found that 17% of black and ethnic minority graduates from the UK failed the CSA on their first attempt as opposed to 4.5% of white British graduates.

The fail rate increases dramatically for black and ethnic minority candidates from outside the UK, with 65% failing the CSA first time.

Professsor Aneez Esmail, Professor of General Practice at the University of Manchester, said:  “With continuing dependence on international medical graduates in meeting the workforce needs of many developed countries, including the UK, understanding the barriers that these doctors face in entering and completing specialist medical training is important.”

“While it could be that an accent leads to additional problems and the patient not being forthcoming, what is particularly worrying is the amount of British ethnic minority candidates who are failing,” he said.

Controlling for age, sex and performance, the researchers based in The University’s Institute of Population Health, say they “cannot exclude subjective bias owing to racial discrimination in the marking of the clinical skills assessment as a reason for these differential outcomes.”

The exam is part of the national MRCGP (Membership of the Royal College of General Practitioners) and the research, from between 2010 and 2012, was published on the British Medical Journal website.

The RCGP have challenged Professor Esmail’s findings by arguing that it contradicts his General Medical Council investigation into the same issue.

In a statement RCGP Chair, 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.”

“We are hugely disappointed that the British Medical Journal has inexplicably decided to fast-track the peer review process for their article. The process undertaken calls into question whether the reviewers had time to fully consider the findings of the official GMC report. This makes a mockery of the whole process,” she said.

According to the Royal College of General Practitioners’ website, all examiners for the CSA are working NHS GPs from across the UK, who are carefully selected, trained and monitored.

Professor Gerada added: “The RCGP takes equality and diversity issues extremely seriously and strongly refutes any allegations that the MRCGP exam is discriminatory in any way.”

A BMJ Careers investigation also published yesterday revealed that white doctors are almost three times more likely to secure senior hospital jobs than ethnic minority doctors.

Looking at last year’s ethnicity data from 50 hospital trusts in England, the BMJ discovered that black or black British applicants were the least likely to be employed as hospital doctors with just a 2.7% success rate, while 3.5% applicants of mixed ethnicity were successful and 5.7% of Asian and Asian British candidates, compared to 13.8% of white applicants.

BMJ Careers Editor, Tom Moberly said: “Interestingly, doctors who did not disclose their ethnicity during the application process had the highest success rate in landing jobs of any ethnic group (23%) – further muddying the waters around potential discrimination in the appointment of NHS doctors.”

Professor Esmail said: “Both my paper and this investigation reflect what is happening in wider society and show that even at top level jobs there is discrimination.”

The British International Doctors Association said these findings ‘add weight to the possibility that the NHS is discriminatory in how it appoints doctors to posts’, while the British Medical Association said the findings were ‘concerning as any form of discrimination is unacceptable in today’s NHS’.

Picture courtesy of Michael Tam, with thanks.

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