Racial discrimination against ethnic minority trainee doctors
UK ethnic minority doctors are four times more likely than white candidates to fail their clinical GP exam, the General Medical Council has found.
The review into 5,000 candidates was ordered after ethnic minority students complained the exam was unfair.
Britain’s leading medical journal was threatened with legal action by the family doctors’ professional body over a report that considered whether there was racial bias in the way that trainee GPs are examined.
The article by a leading academic in the British Medical Journal, (BMJ) said that “subjective bias owing to racial discrimination” could not be ruled out as a reason for consistently high failures rates among ethnic trainees taking the Membership of the Royal College of General Practitioners (MRCGP) exam. Doctors must pass this to practise as a GP in the UK.
The college is facing a judicial review brought by the British Association of Physicians of Indian Origin (Bapio) over low pass rates for doctors from ethnic minorities in the clinical skills assessment (CSA) component of the exam, which involves a mock GP consultation, with an actor posing as the patient.
Professor Esmail’s report for the BMJ was published on the same day as an official review of the exam, also written by him, which was commissioned by the General Medical Council following long-standing concerns about its fairness. His six-month review found that ethnic minority doctors trained in the UK were four times more likely to fail the exam at the first attempt than UK-trained white candidates, while ethnic minority doctors trained abroad were 14 times more to fail.
In the GMC report, Professor Esmail stated, “My report clearly stated that there were problems,” he said. “It identified major differences in outcome between British-trained ethnic minority graduates and white graduates, and also showed big differences between international graduates and British graduates. I absolutely refute this notion that I exonerated them.”
Fiona Godlee, editor-in-chief of the BMJ, confirmed that the journal had been asked by the RCGP to make changes ahead of publication. “We received emails from the college asking us to change the paper, to make changes to the title and the abstract of the paper and to reissue the press release,” she said. “We responded saying that we had no plans to [do so]. This was followed by a lawyer’s letter repeating the demand and adding that they considered it defamatory. We said that we felt it would be damaging to our reputation and theirs if we made a change to a research paper in response to their request.”
Dr Ramesh Mehta, president of Bapio, said that his concerns over discrimination went beyond the exam, and that the medical establishment was guilty of institutional racism. “There is stereotyping of ethnic minority doctors, that they are not up to the mark,” he said. “This is the effect of institutional racism, which is reflected into the examination scenario. There is no doubt that there is a problem. It is not the whole profession, but when it comes to the establishment, there is a problem.”
