India, Pakistan and Nigeria: Scandal of the failing foreign doctors who demand right to sit GP exams a staggering SIX times

Hundreds of foreign doctors working in the NHS are routinely failing key medical exams, The Mail on Sunday can reveal.

Success rates are so poor that medical associations want doctors to be allowed six attempts at passing the tests rather than the current four.

The revelation raises fears the trainee medics, mainly from India, Pakistan and Nigeria, are not suitably qualified to treat patients despite spending three years working for the NHS before taking the exam.

Until they pass the exams, which qualify them to practise independently as hospital physicians or GPs, trainees continue to see patients – under supervision – in placements at hospitals and GP surgeries.

Figures show that foreign doctors are substantially more likely to fail than UK graduates, with communication cited as one of the problems.

While just nine per cent of British doctors fail to pass the knowledge and practical exams, more than  63 per cent of foreign doctors do not reach the standard to pass.

Many take the exams up to the current maximum of four times and there is no way for patients to check how many times their GP failed before becoming fully qualified.

Foreign medical associations are now demanding that doctors are given two additional opportunities to pass the tests amid claims that examiners may be discriminating against non-UK graduates.

Doctors take their professional GP exams

The British Association of Physicians of Indian Origin (BAPIO) said it had not ruled out taking legal action against the British medical colleges which set the exams.

But their claims have been refuted by leading UK specialists who say a recent study showed ‘no substantial effects of gender or ethnicity on examiner/candidate interactions’, and that passing the exams is dependent on having the appropriate skills.

Joyce Robins, co-director of campaign group Patient Concern, said: ‘This is scandalous. If a doctor can go on failing they shouldn’t be treating patients in the NHS and that should be stopped.

‘There has to be a cut-off point and four attempts is too many.’

Shadow Health Minister Andrew Gwynne said: ‘Any attempt to make it easier for doctors to pass these tough exams must be resisted.’

The row centres on foreign doctors who are training to become GPs – but a similar difference in pass rates has been observed among doctors hoping to become hospital physicians and psychiatrists.

About 3,000 doctors a year take their final professional GP exams, set by the Royal College of GPs.

Of those, approximately a third are from outside Europe and did not complete their basic medical training in the UK.

In these cases, they are permitted to apply for NHS training posts, involving three years working in placements.

The difference in the failure rate between UK and non-UK doctors is particularly pronounced in a part of the exam observing candidates in a mock consulting room, faced with 13 actors posing as patients.

The test examines their knowledge, ability to ask important questions and listen to patients’ needs.
Figures show that 63 per cent of foreign doctors failed the test, with communication one of the main problems.

They revealed that 13 per cent of foreign candidates did ‘not use language and/or explanations that are relevant and understandable to the patient’, even though all have taken English tests before working in the NHS.

Only 3.8 per cent of UK candidates demonstrated similar communication problems.

Of the Indian doctors taking the test, 63 per cent failed at the first attempt. For those from Pakistan, there was a 62 per cent failure rate, while 68 per cent of Nigerian doctors failed at the first try.

Foreign doctors were also more likely to fail in a three-hour knowledge test, which is marked anonymously and electronically, ruling out discrimination.

Figures show 16 per cent of UK graduates failed this compared with 46 per cent of foreign doctors.
Clare Gerada, president of the Royal College of GPs, wrote to 10,000 trainee GPs this week ‘to set the record straight’ on the examination.

The letter said: ‘As in any exam, a pass cannot be guaranteed just because you have completed your training and paid to take the exam. This would be a great disservice to you, the College and, most importantly, to patients.’

Dr Ramesh Mehta, president of BAPIO, said the exam system was ‘faulty’. He added: ‘There is a very robust system of selection to get on to NHS training in the first place.

Doctors are then only put forward for exams when trainers say they are ready and are happy with their clinical and communication skills.

‘We don’t want to compromise as far as patient safety or standards of the exam are concerned. But we are worried that the way one part of the exam is organised is wrong.’

Dr Sabyasachi Sarker, president  of the British International Doctors Association, said: ‘Four attempts is just too low – although we want to extend it to six for all doctors, not just those who are foreign.

'It may not be discrimination, but possibly just an unconscious bias on the part of the examiners.’

dailymail.co.uk