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cyrus

Racism and Examinations

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Having read the article by Prof. Oyebode (Bulletin Feb. 07) I was shocked by the unrepentant manner in which he tried to justify such disproportionate discrepancy in the number of Asian and Black candidates failed by the Membership Examination (more than twice their White counterparts). The proof is in the pudding! These figures are disgraceful and blatant evidence of ongoing racial discrimination during these exams, and I believe that many perfectly competent Juniors Doctors have not been allowed to progress in their careers because of it.

Unless direct pressure is brought on the College, particularly from Junior Doctors, there are unlikely to be substantial changes with the new format. With MTAS, IMG visa situation, and other similar debacles, a prejudiced examination process is the last thing psychiatry needs. We should all make ourselves heard and not suffer in silence. In my experience, The College would only listen and take note if forced to. The BMA, as well you local MP, should be very interested in Prof. Oyebode’s article.

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I'm not being funny but have you ever considered other reasons that IMGs fail??

Language skills perhaps?

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That's the main debate. Isn't it? How much language ability should play a part and how much knowledge base is needed. From the results it appears that language skills/ability to use correct words seems to hold the advantage. Especially considering that one has to discuss everything in 10 minutes. Having taken the exams recently I feel part 2 is more about language skills and how much you practice before the exam. It can be argued both sides. But one has to find the right balance. Otherwise there is a danger of people with good language skills without the required practical skills getting away with the exam.

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That's the main debate. Isn't it? How much language ability should play a part and how much knowledge base is needed. From the results it appears that language skills/ability to use correct words seems to hold the advantage. Especially considering that one has to discuss everything in 10 minutes. Having taken the exams recently I feel part 2 is more about language skills and how much you practice before the exam. It can be argued both sides. But one has to find the right balance. Otherwise  there is a danger of people with good language skills without the required practical skills getting away with the exam.

Well ! isn't that the case already to some extent ? Look around yourself and you'll find people with good language skills but little clinical wisdom in positions of power

Language skills are important , and perhaps more in psychiatry than any other speciality, but that can't be at the expense of knowledge and clinical expertise, and the big question is : is this exam assessing those skills ? I personally feel that the exam is highly biased in favour of good communication skills and does not adequately assess clinical skills

and why do we always offer the excuse for IMG's failing because of poor language skills ? i disagree with that , i think IMG's generally have excellent communication skills, at least the lot that i know of have these skills .

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People shouldn't make the assumption that the exam is able to identify the best clinicians. All the exam does is select thouse who can pass the exam. I would say that in psychiatry good communication skills are more important than clinical skills, because without the ability to gain rapport and get you patient to talk to you, then you will not be able to ellicit any clinical signs anyway. I suspect it is the little nuances and turns of phrase that put people at ease that make an impression in the exam, as it reassures the examiners that the candidate is a 'safe' one.

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I agree with oceanic that most IMGs who reach the Part 2 exam stage  have good enough communication skills needed to pass the exam. In addition IMGs have excellent patient interviewing skills and showing good empathy to patients has never been a  problem with overseas doctors in my experience.

I think the reasons for IMGs not doing well in Part 2 exams are multifactorial. Not having trained from school/later in a logical way to approach a practical problem (which I presume our British colleagues are accustomed to ) could be one of the many reasons.

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I'm not being funny but have you ever considered other reasons that IMGs fail??

Language skills perhaps?

I've decided that anon, Scavol, E.J. etc MUST be kidding around because surely no-one who plans on a career in psychiatry could hold such dreadful stereotypes.

As 'anon' has put forward yet another stereotype I thought I'd highlight some of the posts from someone who is so inordinately proud of being a 'local' (gosh - even WRITING that feels so 'League of Gentlemen'!).

SO some quotes from anon :

I only qualified in 2003 and passed my part I at first opportunity (only 18/12 into training)

Missing the words ' [highlight]the earliest[/highlight]' ? Also - I think the idea is to pass the part one after 12 months NOT 18.

which unless you're clairvoyant is tricky

[highlight]A[/highlight] clairvoyant perhaps?

Also does anyone know any agencies or websites that specialise in assisting candidates with their applications?

One particular site I came across was www.apply2medicine.co.uk

Anyone know of this? Looks quite good!

Don't even know WHAT to say about this - no syntactical issues here but certainly paddling in the murky end of the ethics pool.

Finally anon - before the inevitable tirade of abuse which I fully expect - I'd just like to say (regarding your 'IMGs have poor language skills' comment):

'Pot - meet the kettle' .

I'm sure this shan't stop you posting Anon - and that is a good thing. All opinions should be welcome in an open forum such as this one. We don't have to agree with each other, but civility and respect amongst professionals should be upheld.

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From Cyrus:

These figures are disgraceful and blatant evidence of ongoing racial discrimination during these exams, and I believe that many perfectly competent Juniors Doctors have not been allowed to progress in their careers because of it.

I haven't started preparing for the Critical Appraisal paper but that is a rather serious allegation to make.

When I was at the Part 1 exam the ethnic distribution was not equal. If more men and women of colour do an exam and - assuming a certain percentage of ALL candidates fail - surely the diversity of the failed candidates will reflect this?

Bias can extend well beyond the colour of your skin - how many examiners would be happy passing a candidate with long hair, a prominent body piercing, or just general dishabille?

I'm sure most of us would agree that postgraduate examinations are rather random - as anyone who sat the paper two weeks ago would attest to. Passing that exam does not make me a better or worse psychiatrist that someone who failed it.

There's also always an element of luck!

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People shouldn't make the assumption that the exam is able to identify the best clinicians. All the exam does is select thouse who can pass the exam. I would say that in psychiatry good communication skills are more important than clinical skills, because without the ability to gain rapport and get you patient to talk to you, then you will not be able to ellicit any clinical signs anyway. I suspect it is the little nuances and turns of phrase that put people at ease that make an impression in the exam, as it reassures the examiners that the candidate is a 'safe' one.

Agreed  :)

But ability to empathise is more or less a gift people have, and some people are good at making people feel at ease than others , i don't think it's only the verbal communication skills which matter ; it is something more , some kind of charm ; vibes , that kind of stuff, simply holding someone's hand without uttering a word , emotions don't depend upon language

It is no use to have great communication skills without the ability to understand the pain and suffering of the clients , which doesn't really need any language skills

and just try and see what all our colleagues in other specialities do , hardly any communication , but they still command respect and confidence of public

I think , we in psychiatry tend to be over cautious and over conscious about these issues, which is great , but don't make these skills the criteria against which to judge future doctors

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Quote:

which unless you're clairvoyant is tricky

A clairvoyant perhaps?

Clairvoyant is an adjective as well as a noun. The use of the word in this sentence was correct.

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I looked at the current (Spring 07) Part 1 written results and as a very rough estimate, about 10% of the names on the pass list were Anglo-Saxon names, which means as a very very crude measure, 90% of the names are foreign - now these may be non-Englaish names, but born here, like myself and of course overseas candidates, so the majority taking and passing the exams are non-white.

Having said that psychiatry is a purely based communication specialty and so if your native language is English, then you are more likely to pass!...that sounds sensible. With more and more non-English graduates sitting the exam, I'm sure that they can't fail everyone...otherwise they will be no more trainees...altough in ten years, I'm sure that nurses will be RMOs!!

On a separate issue, i am concerned about the new format of the exam...don't let me get started on that!!!

Good luck for the clinicals

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I think most of us would agree that this exam is subjective and unfair. I have heard the current Dean on at least two occasions, including at last year's Annual Conference, say that candidates who pass this exams are those who are [highlight]“good at passing exams.” [/highlight]Passing or failing MRCPsych at best correctly distinguishes between very good and very poor candidates – many in the ‘shades-of-grey’ region in between are dependant on luck or other factors (including, I would argue, colour of skin and accent).

At a time when there was a serious shortage of psychiatrist in UK (late 80s and 90s), as well as many vacant SpR posts – so much so that The College went oversees in order to import psychiatrists – giving UK based psychiatrists NTNs without Membership could have resolved this shortage.

What it comes down to is this. The College is a remnant of an Old Boys Network exclusive club. It insists on an 'initiation ritual' in order to allow new members to join. Hence we have this exam. We are much better without it.

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I think we all have to deal with being judged daily - so the exams are not particularly different from real life in that respect.

I enjoyed studying for the exams. We are lucky in psychiatry that we have a lot of protected study time and I can frequently study even when on-call.

The exams are odd - but the actual preparation for it increased my theoretical knowledge massively and I enjoyed the process so much - even if a lot of my knowledge was never tested!

There are lots of people who have membership but don't have NTNs - which I find strange given the number of consultants who DON'T have membership.

IMHO - the membership exam helps us - it is a vital part of lifelong learning. The exams themselves may be subjective but MTAS was supposed to be objective and look at what a fiasco it turned out to be.

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There are lots of people who have membership but don't have NTNs - which I find strange given the number of consultants who DON'T have membership.

Yes. It is all about planning!! One minute psychiatry dosen't have people the next minute it is bursting at its seams. Psychiatry may still lose all these people with membership though.

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I do think that the notion of an old boys network is gradually diminishing. I don't know if that could be said for the othe colleges, e.g. surgeons and obs & gynae, where you still fit in, if you are 'one of us.' The fact that an increasing number of trainees are female certainly combats that view.

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