Performance of ethnic minority versus White doctors in the MRCGP assessment 2016–2021: a cross-sectional study

Aloysius Niroshan Siriwardena; Vanessa Botan; Nicki Williams; Kim Emerson; Fiona Kameen; Lindsey Pope; Adrian Freeman; Graham Law

doi:10.3399/BJGP.2022.0474

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The difference in the motivation for becoming general practitioners
Ryuichi Ohta

Published on: 10 April 2023
Ethnicity did not predict performance in GP licensing of doctors entering GP training
Aloysius N. Siriwardena, Vanessa Botan, Nicki Williams, Kim Emerson, Fiona Kameen, Lindsey Pope, Adrian Freeman and Graham Law

Published on: 05 April 2023
Performance of ethnic minority versus White doctors in the MRCGP assessment 2016–2021: a cross-sectional study
Naureen Bhatti and Vijay Nayar

Published on: 21 March 2023

Published on: (10 April 2023)
Page navigation anchor for The difference in the motivation for becoming general practitioners
The difference in the motivation for becoming general practitioners
Ryuichi Ohta, Family physician, Unnan City Hospital, Japan
This study’s impact is significant, considering GP education worldwide.¹ The gap among different ethnicity regarding academic and practical performance has narrowed. Based on this research, ethnicity is not related to clinical performances based on objective clinical assessment, which can contribute to better care in general practice. This result may show the equality of academic and practical assessment in general practice medical education, driving more medical students to become general practitioners.

One of the vital factors contributing to this study’s results is the motivation to become general practitioners among medical students. Even now, academic assessments may be biased based on ethnicity and gender.^2,3 They may overcome the difficulties of the biases by making efforts with high motivation. Their motivation and perception regarding becoming general practitioners should be assessed compared with the majority of medical students. The involvement of variables regarding motivation in research can clarify the reality of their performance.

References
1. Siriwardena AN, Botan V, Williams N, et al. Performance of ethnic minority versus White doctors in the MRCGP assessment 2016-2021: a cross-sectional study. Br J Gen Pract 2023;73(729):e284-e293. DOI: 10.3399/BJGP.2022.0474.
2. Polanco-Santana JC, Storino A, Souza-Mota L, Gangadharan SP, Kent TS. Ethnic/Rac...
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This study’s impact is significant, considering GP education worldwide.¹ The gap among different ethnicity regarding academic and practical performance has narrowed. Based on this research, ethnicity is not related to clinical performances based on objective clinical assessment, which can contribute to better care in general practice. This result may show the equality of academic and practical assessment in general practice medical education, driving more medical students to become general practitioners.

One of the vital factors contributing to this study’s results is the motivation to become general practitioners among medical students. Even now, academic assessments may be biased based on ethnicity and gender.^2,3 They may overcome the difficulties of the biases by making efforts with high motivation. Their motivation and perception regarding becoming general practitioners should be assessed compared with the majority of medical students. The involvement of variables regarding motivation in research can clarify the reality of their performance.

References
1. Siriwardena AN, Botan V, Williams N, et al. Performance of ethnic minority versus White doctors in the MRCGP assessment 2016-2021: a cross-sectional study. Br J Gen Pract 2023;73(729):e284-e293. DOI: 10.3399/BJGP.2022.0474.
2. Polanco-Santana JC, Storino A, Souza-Mota L, Gangadharan SP, Kent TS. Ethnic/Racial Bias in Medical School Performance Evaluation of General Surgery Residency Applicants. J Surg Educ 2021;78(5):1524-1534. (In eng). DOI: 10.1016/j.jsurg.2021.02.005.
3. Li B, Jacob-Brassard J, Dossa F, et al. Gender differences in faculty rank among academic physicians: a systematic review and meta-analysis. BMJ Open 2021;11(11):e050322. (In eng). DOI: 10.1136/bmjopen-2021-050322.
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Competing Interests: None declared.
Published on: (5 April 2023)
Page navigation anchor for Ethnicity did not predict performance in GP licensing of doctors entering GP training
Ethnicity did not predict performance in GP licensing of doctors entering GP training
Aloysius N. Siriwardena, Professor of Primary and Prehospital Health Care, University of Lincoln
Other Contributors:
Vanessa Botan, Postdoctoral Research Associate, University of Lincoln

Nicki Williams, General Practice National Recruitment Office Research and Development Lead, Health Education England

Kim Emerson, Clinical Lead for Workplace Based Assessment, Royal College of General Practitioners

Fiona Kameen, Medical Director Quality Management and Training Standards, Royal College of General Practitioners

Lindsey Pope, Professor of Medical Education, University of Glasgow

Adrian Freeman, Emeritus Professor., Exeter University

Graham Law, Professor of Medical Statistics, University of Lincoln
We thank Drs Bhatti and Nayar for responding to our study. They present no evidence to contradict our findings and, despite misunderstanding our analysis and interpretation, reach similar conclusions.

Our study challenges their assertion, that ethnic minority trainees, in particular UK trained ethnic minority doctors in GP specialty training, fail MRCGP due to their ethnicity. We showed that this was not the case in our cohort.¹ Their focus on racial discrimination in the workplace and during training implies the non-sequitur, that differential attainment must be de due to unfair discrimination by examiners and examinations, or educators in the case of workplace-based assessment. In doing so they denigrate the many ethnic minority doctors in speciality training who pass MRCGP, supported by educators.

Increasing numbers of ethnic minority and overseas qualified doctors complete the MSRA, a computer marked assessment of clinical knowledge and judgement, and enter specialty training for general practice. They claim that we ‘do not seem to have been taken into account…differential attainment in the MRSA exam’, but this is exactly what we have done.
The GMC report, ‘Tackling disadvantage in medical education’, which shows differential attainment in trainees in all specialties, by separately analysing characteristics such as ethnicity, gender and disability,^2...
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We thank Drs Bhatti and Nayar for responding to our study. They present no evidence to contradict our findings and, despite misunderstanding our analysis and interpretation, reach similar conclusions.

Our study challenges their assertion, that ethnic minority trainees, in particular UK trained ethnic minority doctors in GP specialty training, fail MRCGP due to their ethnicity. We showed that this was not the case in our cohort.¹ Their focus on racial discrimination in the workplace and during training implies the non-sequitur, that differential attainment must be de due to unfair discrimination by examiners and examinations, or educators in the case of workplace-based assessment. In doing so they denigrate the many ethnic minority doctors in speciality training who pass MRCGP, supported by educators.

Increasing numbers of ethnic minority and overseas qualified doctors complete the MSRA, a computer marked assessment of clinical knowledge and judgement, and enter specialty training for general practice. They claim that we ‘do not seem to have been taken into account…differential attainment in the MRSA exam’, but this is exactly what we have done.
The GMC report, ‘Tackling disadvantage in medical education’, which shows differential attainment in trainees in all specialties, by separately analysing characteristics such as ethnicity, gender and disability,² does not contradict our findings. We used multivariable models taking into account intersections between these attributes to elucidate independent predictors of performance in licensing assessments. Attempts to conflate differential attainment with racial discrimination in assessments, could itself stereotype doctors and will do little to improve their self-worth or educational outcomes.

Fair Training Pathways³ explores the importance of the educational environment, and we welcome educational initiatives to reduce differential attainment, but these do not undermine the reliability of the data or analysis. Increasing inclusivity of selection to GP training means that educational programmes need to be designed accordingly.

Our conclusions are similar, that, ’GP trainees should receive educational support appropriate to their needs, whatever their ethnic group or other demographic characteristics’, but we also refer to ‘doctors admitted to training with low selection scores who may need additional support to maximise their chances of successful licensing.’

References
1. Siriwardena AN, Botan V, Williams N, Emerson K, Kameen F, Pope L, Freeman A, Law G: Performance of ethnic minority versus White doctors in the MRCGP assessment 2016-2021: a cross-sectional study. Br J Gen Pract 2023, 73(729):e284-e293.
2. General Medical Council. Tackling disadvantage in medical education. Analysis of postgraduate outcomes by ethnicity and the interplay with other personal characteristics. In. London: GMC. Tackling disadvantage in medical education (gmc-uk.org)
3. Woolf K, Rich A, Viney R, Rigby M, Needleman S, Griffin A. Fair training pathways for all: understanding experiences of progression. In. London: UCL Medical School, Academic Centre for Medical Education; 2016. Fair Training Pathways for All: Understanding Experiences of Progression - Final Report (gmc-uk.org).

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Competing Interests: Aloysius Niroshan Siriwardena, Kim Emerson, Fiona Kameen, Lindsey Pope and Adrian Freeman received funding from the Royal College of General Practitioners for their roles in the MRCGP, and Nicki Williams received funding in her role at the General Practice National Recruitment Office. No other relationships or activities have influenced the submitted work.
Published on: (21 March 2023)
Page navigation anchor for Performance of ethnic minority versus White doctors in the MRCGP assessment 2016–2021: a cross-sectional study
Performance of ethnic minority versus White doctors in the MRCGP assessment 2016–2021: a cross-sectional study
Naureen Bhatti, Strategic Lead for Workforce Race Equality and Differential Attainment in Primary Care, London, Health Education England
Other Contributors:
Vijay Nayar, Primary Care lead for Differential Attainment for Health Education England
In reviewing the performance of ethnic minority versus White doctors in MRCGP assessment from 2016-21, Siriwardena and colleagues conclude that ethnic background did not reduce the chance of passing GP licensing exams once sex, place of primary medical qualification (PMQ), declared disability and MSRA scores were accounted for.

This conclusion is not in keeping with the recent GMC report¹ which found that UK graduates of black/black British heritage have lower pass rates in specialty exams (62%) than UK white (79%), Asian (68%) and mixed heritage trainees (74%). Having a non-white ethnic background may in itself be an over-simplification and further granularity of the data is required to reach any meaningful conclusions.

Furthermore there is differential attainment in the MRSA exam, “upstream” so to speak, which mirrors that seen in the GMC report. In the MRSA proportionally more Black and Muslim candidates do less well, findings similar to those in the MRCGP, whether UK non-UK graduates. The disparities in attainment due to ethnicity seen in the MRSA do not seem to have been taken into account in the paper.

The paper followed up GP trainees recruited in 2016 of which 23.2% were non-UK graduates. In 2022 this figure was 57% and the profile of our trainees has changed significantly over that time with increased numbers from a non-white background. In addition, Health Education England has introduced a number of init...
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In reviewing the performance of ethnic minority versus White doctors in MRCGP assessment from 2016-21, Siriwardena and colleagues conclude that ethnic background did not reduce the chance of passing GP licensing exams once sex, place of primary medical qualification (PMQ), declared disability and MSRA scores were accounted for.

This conclusion is not in keeping with the recent GMC report¹ which found that UK graduates of black/black British heritage have lower pass rates in specialty exams (62%) than UK white (79%), Asian (68%) and mixed heritage trainees (74%). Having a non-white ethnic background may in itself be an over-simplification and further granularity of the data is required to reach any meaningful conclusions.

Furthermore there is differential attainment in the MRSA exam, “upstream” so to speak, which mirrors that seen in the GMC report. In the MRSA proportionally more Black and Muslim candidates do less well, findings similar to those in the MRCGP, whether UK non-UK graduates. The disparities in attainment due to ethnicity seen in the MRSA do not seem to have been taken into account in the paper.

The paper followed up GP trainees recruited in 2016 of which 23.2% were non-UK graduates. In 2022 this figure was 57% and the profile of our trainees has changed significantly over that time with increased numbers from a non-white background. In addition, Health Education England has introduced a number of initiatives to reduce the impact of differential attainment which may affect the reliability of the data presented in the paper.

Lastly, this analysis does not take into account the lived experience reported by our trainees, whether they be UK non-White trainees or IMGs, as shown in WRES² and MWRES³ data as well as primary care surveys⁴ and the work of Katherine Woolf.⁵

The conclusions in this report should not detract from the fact that differential attainment exists and that ethnicity is a key contributory factor whether you have qualified here or abroad. We need to ensure that we level the medical education field and that all trainees regardless of their background receive the support they need to reach their full potential.

References

1. GMC. Tackling disadvantage in medical education. Analysis of postgraduate outcomes by ethnicity and the interplay with other personal characteristics. 2023. www.gmc-uk.org/-/media/documents/96887270-tackling-disadvantage-in-medical-education-020323.pdf.

2. NHS England. NHS Workforce Race Equality Standard. www.england.nhs.uk/about/equality/equality-hub/workforce-equality-data-standards/equality-standard

3. NHS. Medical Workforce Race Equality Standard (MWRES) 2021. www.england.nhs.uk/wp-content/uploads/2021/07/MWRES-DIGITAL-2020_FINAL.pdf

4. NHS. Health Education England. Discrimination & racism in primary care. 2022. www.hee.nhs.uk/sites/default/files/documents/North%20Central%20London%20-%20discrimination%20survey.pdf.

5. Woolf K. Differential attainment in medical education and training. BMJ 2020;368:m339.
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Competing Interests: None declared.