This article was first published in Sushruta Vol 7 Issue 1 by BAPIO
It is now very well known that BAPIO filed for a judicial
review of the MRCGP examination, especially with regards to the CSA component;
well there is no point beating about the bush, BAPIO lost the case.
That means that the MRCGP was ruled to be a fair
examination, by indirect inference it may be assumed that other examinations
were also likely to be fair. BAPIO members, BME doctors, IMGs can be reassured
that things are rosy and live in joy. I was just about to do that when I found
that Prof Rajan Madhok, Chairman, BAPIO tweeted ‘JR judge says: moral success
but not legal victory! So our laws go against our morals? Crazy’ It is true.
The judge said BAPIO had a moral victory.
So what is that moral victory thing? It is just a judge
being polite?
Pause. Reflect.
To understand this, we have to go back to 7 June 1893. One
Mr MK Gandhi who had a first-class ticket and was travelling in a first-class
rail compartment was thrown off the train. He had a legal right to be on that
train but he still lost his seat in the train; Gandhiji had a moral victory.
The rest was history and what a history it was.
The judicial review has set off a number of changes which we
are beginning to hear about. The GMC is now considering seriously introducing a
common licensing examination for UK graduates and IMGs (similar the
concept of USMLE). The GMC is introducing English language competency tests for
EU doctors (where there is cause for concern). The time allowed for the AKT MCQ
examination of the MRCGP is being increased. There could be changes to the way
CSA is conducted and assessed. There are numerous other changes and many Royal Colleges
and medical educational establishments are engaging with BAPIO and its
partners.
The RCGP and GMC activities considered in the Judicial
Review were ruled legal. Yet they and other institutions are making changes
that further cause of equality. BAPIO contends that these changes would not
have happened at this juncture and at this pace, without the Judicial Review? Are
we beginning to understand the concept of a legal loss and a moral victory?
By the way, Gandhiji protested and was allowed to travel the
next day by first class. In the continuation of the same journey he was beaten
by a driver, banned from hotels and subjected to other forms of abuse.
BAPIO should be under no illusion that things are or soon
will be rosy. The path is strewn with thorns and BAPIO should be prepared for
its skin to be pricked in this journey. What does BAPIO want? BAPIO wants, what
you have always wanted. A level playing field, no bias, high standards, fair
assessment and equal opportunity to progress.
Here are some suggestions on the specifics that BAPIO should
be asking for
1) Real patients rather than role players
2) Increased number of BME/IMG examiners
3) Two examiners on each station
4) Video recording of the session.
5) Improved training of the candidates.
6) Improved training of the trainers and holding to account
of trainers with poor record of success of their trainees.
7) Feedback and mentoring for those who fail
8) Removal of hawk examiners/trainers (especially those who
have negative impact on BME/IMG doctors)
9) Removal of dove examiners/trainers (especially those who
have a negative impact on BME/IMG doctors)
10) Testing and continued monitoring of sub-conscious bias
in examiners/trainers.
11) Examiners with extreme bias not to be selected,
examiners with non-extreme bias to be provided training followed by monitoring.
12) Pass-fail threshold and other standard setting (such as
ARCP/RITA progress) should be tested for impact on various populations with
protected characteristics and where there is no evidence of impact on patient
outcomes the thresholds should be adjusted to reduce any possible negative
impact on doctors with protected characteristics.
13) Objective assessments/examinations for summative,
pass-fail, high-stakes situations/examinations/assessments (with any subjective
assessments reserved for formative processes)
There are many more ideas that will benefit the system.
If BAPIO decides to ask for these and more, you can be
assured BAPIO will be vilified and denounced. The hope is, after the abuse is
done, the changes would happen, even if they were slow.
A couple of thousand of years before Gandhi, we hear of one
Jesus Christ, who lost a legal case and was crucified; he seemed to have won
the moral case quite convincingly. Time will tell, but BAPIO’s moral victory
may turn out to be a very strong force for change.
M HEMADRI
