Inequalities experienced by medical trainees from different ethnic backgrounds have been laid bare by a report from the General Medical Council (GMC).
In particular black doctors are more likely to fail specialty exams than any other ethic group, data from medical royal colleges and postgraduate training bodies collated by the GMC shows.
UK medical graduates of black or black British heritage have lower pass rates in specialty exams (62%) than UK white (79%), Asian (68%) and mixed heritage trainees (74%), figures suggest.
It is the first time the regulator has split the data by ethnicity in a more detailed way after setting a target in 2021 to eliminate discrimination, disadvantage and unfairness in medical education over the next decade.
Other factors such as socio-economic status compound the poorer outcomes seen in some groups, the GMC report said, with UK black trainees from areas with a higher level of deprivation having a 59% pass rate compared to 76% for UK white trainees from an equivalent socio-economic background.
The figures also show that double the number of UK black or black trainee doctors (5.3%) have had their training programme extended than white medics (2.6%).
In addition, UK black doctors are less likely to receive an offer when applying to specialty training at 75% compared with 82% for white trainees, the GMC said.
Race is not the only factor that can disadvantage medical training, the GMC said, with UK Asian Muslim trainees having lower exam pass rates compared to those from a Hindu or Sikh faith and those who do not follow a religion at all.
And specialty exam pass rates are lower for disabled trainees. The figures also show overseas graduates are much less likely to declare a disability than UK graduates.
There is no evidence that the attainment gap between doctors of different ethnicities is significantly narrowing over time, the GMC concluded.
Last year the regulator launched a new hub to provide assistance to doctors who experience racism and discrimination at work.
The same month, the GMC admitted that a controversial case in which a GP was accused of dishonesty after saying she had been ‘promised’ a laptop ‘damaged’ efforts to build trust with doctors from minority ethnic backgrounds.
Professor Colin Melville, GMC medical director and director of education and standards, said: ‘These new data underline the detriment and lived experience of ethnic minority doctors.
‘At all stages of a doctor’s career, disadvantage and discrimination continues to undermine opportunities for development and progression. And this can have a negative impact on patient care.
‘All of us have a role to play in tackling this vital issue. We want to scale up initiatives that work in eliminating the barriers that social background creates and we want to use our position to build up an evidence base on what drives best practice.’
Dr Sai Pillarisetti, BIDA junior doctor chair, said: ‘The report confirms what we have long known to be true – that trainees of Black and Asian heritage have significantly lower rates of passing specialty exams and that this disparity extends far beyond exams and also impacts progression, with these groups more likely to experience extension to their training time and lower success rates when applying for specialty training posts.
‘It is imperative for the relevant bodies to take notice of this report and take meaningful action to make these exams more equitable to those from all backgrounds.’
He added this should include involving those from minority ethnic backgrounds in question creation and design, having proportional representation on examination boards and
unconscious bias training for examiners.
Dr Naureen Bhatti, a GP in London and HEE London primary care lead for workforce race strategy, said the more detailed breakdown of ethnicity and other factors in training was long overdue.
The findings were not surprising she added but it was ‘incredibly sad and shocking to see nothing has improved’.
Additional funding that has been made available to support international medical graduate trainees has been very welcome but it still focuses on the individual rather than addressing structural issues such as racism in the NHS and biased recruitment processes, she added.
‘We have been working on a race equality strategy for primary care where we are trying to highlight the bigger picture. This has given us the information but it’s what we do with it,’ she said.
Simply call it racism.
I don’t think it is credible to attribute all variance in a complex outcome, exam performance, to a single predictor variable, alleged racism at the royal college.
Have you been part of the exam setting or quality assurance processes to say at what stage the alleged racism is having influence? Certainly in my experience Royal College exams committees and question writers are considerably more diverse than the British population as a whole.
Have all possible predictor variables which may vary by ethnicity but are either not racism related or related to structural inequalities not within the royal colleges control been accounted for? For illustration and one of many possible examples, more black and Asian households include dependent children, having done exams myself before and after having children I can tell you exam revision is definitely more difficult with kids!
I have been in NHS practice for over 3 decades and never faced sanctions being imposed on me but from my experience of the GMC cases I have seen around me during this time and in my opinion , the GMC is one of the most racist, unbalanced and untrustworthy organisations one could possibly imagine. The GMC is as untrustworthy as the RCGP is incompetent and detached from its members (also a member of this useless organisation)
Benjamin Williams makes some excellent points. Equality of outcome should always be strived for by equality of opportunity, but we have to be careful of the dangers of “positive discrimination”. If all racial groups had an identical pass rate, would that not appear even more peculiar? If examiners were constantly conscious of ensuring a (say) 70% pass rate across the board, would they not feel under pressure to mark up one racial group (and mark down another) to achieve this and thus avoid the accusation of racism? Surely this would be more racist, not less.
Unless there is distinct evidence of racial bias amongst examiners then we should look again at equality of opportunity to ensure disadvantaged candidates are given a fair shake at passing their exams,
Clear and consistent evidence of systemic and institutional racism in organisations supposed to support and nurture doctors. No sign of improvement over the years. Status-quo intentionally maintained.