Racial discrimination against black and ethnic minority trainee doctors 'can’t be ruled out', warns expert

Furious row and threat of legal action as academic says professional body refuses to admit problem

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 black and Asian 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.

Before the report's publication, the Royal College of General Practitioners (RCGP) wrote to the journal, asking it to change both the title, which included the word "discrimination", and the summary of the paper, which contained the explosive warning over possible racial bias. The college followed up its request with a lawyer's letter saying it considered the report to be "defamatory".

The revelation comes amid a furious row over the report, which the BMJ eventually published in full two weeks ago. Its author, Professor Aneez Esmail, a leading academic and GP, has accused the RCGP of "refusing to accept there is a problem" with the exam and trying to brush concerns about possible bias "under the carpet". 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 likely to fail. The two reports used the same data.

In the GMC report, Professor Esmail and co-author Professor Chris Roberts say they cannot "confidently exclude bias from the examiners in the way that they assess non-white candidates", but did not include the specific statement that "subjective bias owing to racial discrimination" cannot be ruled out – leading to disagreement over their conclusions.

The RCGP responded with dismay to the BMJ report. Dr Clare Gerada, chair of the RCGP, said the GMC report had found "no evidence of discrimination" and accused Professor Esmail of contradicting himself by "misleadingly" suggesting the RCGP may be biased in the way it assesses candidates. However, Professor Esmail told The Independent on Sunday that he "absolutely refutes" any notion that his report for the GMC exonerated the RCGP, and claimed the college was guilty of attempting to downplay his findings ahead of the Bapio judicial review.

"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."

Bapio has gained permission to take the RCGP to judicial review over the exam. It is also seeking to include the GMC in the claim, but was denied permission, a decision which it is appealing at a hearing this week.

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."

Dr Gerada said: "The RCGP takes equality and diversity issues extremely seriously and strongly refutes any allegations that the MRCGP exam is discriminatory in any way. We already take comprehensive steps to ensure that the exam is fair and equitable to all candidates."

Niall Dickson, chief executive of the GMC, said: "We agree with Professor Esmail that there is no room for complacency. We want to work with him. We are duty bound to act where there is evidence of a problem. His report makes a powerful case for action."

John Travolta is a qualified airline captain and employed the pilot with his company, Alto
people'That was the lowest I’d ever felt'
Life and Style
healthIt isn’t greasy. It doesn’t smell. And moreover, it costs nothing
Jonas Gutierrez (r) competes with Yaya Toure (l)

Newcastle winger is in Argentina having chemotherapy

Arts and Entertainment
Blossoming love: Colin Firth as Stanley and Emma Stone as Sophie, in 'Magic in the Moonlight'

Actors together in Magic in the Moonlight: Woody Allen's 1920s romance

Life and Style
ebooksA superb mix of recipes serving up the freshest of local produce in a delicious range of styles
Life and Style
ebooksFrom the lifespan of a slug to the distance to the Sun: answers to 500 questions from readers
peopleThe Times of India said actress should treat it as a 'compliment'

Watch this commuter wage a one-man war against the Circle Line
We are phenomenally good at recognising faces; the study showed that humans have been selected to be unique and easily recognisable

Human faces unique 'because we don't recognise each other by smell'

Arts and Entertainment
You've been framed: Henri Matisse's colourful cut-outs at Tate Modern
artWhat makes a smash-hit art show?
Home body: Badger stays safe indoors
lifeShould we feel guilty about keeping cats inside?
A male driver reverses his Vauxhall Astra from a tow truck

Man's attempt to avoid being impounded heavily criticised

Arts and Entertainment
US pop diva Jennifer Lopez sang “Happy Birthday” to Gurbanguly Berdimuhamedow, president of Turkmenistan
musicCorporate gigs become key source of musicians' income
Arts and Entertainment
While many films were released, few managed to match the success of James Bond blockbuster 'Skyfall'
filmsDaniel Craig believed to be donning skis as 007 for first time
The Guildhall School of Music and Drama is to offer a BA degree in Performance and Creative Enterprise

Arts and Entertainment
Emma Thompson and Bryn Terfel are bringing Sweeney Todd: The Demon Barber of Fleet Street to the London Coliseum

Returning to the stage after 20 years makes actress feel 'nauseous'

Arts and Entertainment
Pulp-fiction lover: Jarvis Cocker
booksJarvis Cocker on Richard Brautigan
Arts and Entertainment
Robin Thicke and Pharell Williams in the video of the song, which has been accused of justifying rape
music...and he had 'almost no part' in writing it
Latest stories from i100
Have you tried new the Independent Digital Edition apps?

ES Rentals

    Independent Dating

    By clicking 'Search' you
    are agreeing to our
    Terms of Use.

    iJobs Job Widget
    iJobs General

    Data Warehouse Developer / Analyst (SQL, SSIS, stored procedures)

    £40000 - £50000 Per Annum + excellent benefits: Clearwater People Solutions Lt...

    Year 6 Teacher

    £110 - £130 per day + D.O.E - Competitive Rates: Randstad Education Maidstone:...

    March On Cancer™ - Local Marketing and Promotions Volunteer

    This is an unpaid voluntary role.: Cancer Research UK: We need motivational vo...

    SEN Coordinator + Teacher

    £1 per day: Randstad Education Leeds: Job Purpose To work closely with the he...

    Day In a Page

    Mystery of the Ground Zero wedding photo

    A shot in the dark

    Mystery of the wedding photo from Ground Zero
    His life, the universe and everything

    His life, the universe and everything

    New biography sheds light on comic genius of Douglas Adams
    Save us from small screen superheroes

    Save us from small screen superheroes

    Shows like Agents of S.H.I.E.L.D are little more than marketing tools
    Reach for the skies

    Reach for the skies

    From pools to football pitches, rooftop living is looking up
    These are the 12 best hotel spas in the UK

    12 best hotel spas in the UK

    Some hotels go all out on facilities; others stand out for the sheer quality of treatments
    These Iranian-controlled Shia militias used to specialise in killing American soldiers. Now they are fighting Isis, backed up by US airstrikes

    Widespread fear of Isis is producing strange bedfellows

    Iranian-controlled Shia militias that used to kill American soldiers are now fighting Isis, helped by US airstrikes
    Topshop goes part Athena poster, part last spring Prada

    Topshop goes part Athena poster, part last spring Prada

    Shoppers don't come to Topshop for the unique
    How to make a Lego masterpiece

    How to make a Lego masterpiece

    Toy breaks out of the nursery and heads for the gallery
    Meet the ‘Endies’ – city dwellers who are too poor to have fun

    Meet the ‘Endies’ – city dwellers who are too poor to have fun

    Urbanites are cursed with an acronym pointing to Employed but No Disposable Income or Savings
    Paisley’s decision to make peace with IRA enemies might remind the Arabs of Sadat

    Ian Paisley’s decision to make peace with his IRA enemies

    His Save Ulster from Sodomy campaign would surely have been supported by many a Sunni imam
    'She was a singer, a superstar, an addict, but to me, her mother, she is simply Amy'

    'She was a singer, a superstar, an addict, but to me, her mother, she is simply Amy'

    Exclusive extract from Janis Winehouse's poignant new memoir
    Is this the role to win Cumberbatch an Oscar?

    Is this the role to win Cumberbatch an Oscar?

    The Imitation Game, film review
    England and Roy Hodgson take a joint step towards redemption in Basel

    England and Hodgson take a joint step towards redemption

    Welbeck double puts England on the road to Euro 2016
    Relatives fight over Vivian Maier’s rare photos

    Relatives fight over Vivian Maier’s rare photos

    Pictures removed from public view as courts decide ownership
    ‘Fashion has to be fun. It’s a big business, not a cure for cancer’

    ‘Fashion has to be fun. It’s a big business, not a cure for cancer’

    Donatella Versace at New York Fashion Week