Differential attainment in the MRCPsych according to ethnicity and place of qualification between 2013 and 2018: a UK cohort study

Postgrad Med J. 2020 Sep 3;postgradmedj-2020-137913. doi: 10.1136/postgradmedj-2020-137913. Online ahead of print.


Purpose of the study: To explore if differential pass rates exist in the clinical component of the UK postgraduate clinical psychiatry exam, the Clinical Assessment of Skills and Competencies (CASC), according to ethnicity and place of qualification (UK vs EEA vs overseas graduates).

Study design: Observational study using data from the UK Medical Education Database for 2140 doctors sitting the CASC for the first time between 2013 and 2018.

Results: After controlling for age, sex, time of sitting and performance in the written components of the MRCPsych, differences in CASC pass rates persisted between UK graduates self-identifying as Black and Minority Ethnicity (BME) and non-BME (OR for passing 0.36, 95% CI 0.23 to 0.56, p<0.001). Both EEA (OR 0.25, 0.15 to 0.40, p<0.001) and overseas graduates (OR 0.07, 0.05 to 0.11, p<0.001) were less likely to pass the CASC at first attempt, even after controlling for the influence of educational and background variables. These groups, on average, had lower scores on written exams with substantial content relating to procedural skills (eg, critical appraisal) rather than pure recall of factual knowledge.

Conclusions: Substantial differences exist in clinical examination performance between UK BME and non-BME candidates, as well as between UK and non-UK graduates. These differences are not explained by differing levels of clinical knowledge. In the interests of equality, this situation requires further investigation and remediation. Future research should focus on understanding how potential bias may be acting within different stages of recruitment, training and assessment within psychiatry.

Keywords: Psychiatry; medical education & training.