• Paul A Tiffin and Lewis W Paton.
• Mental Health and Addictions Research Group, Department of Health Sciences,, University of York, York, UK paul.tiffin@york.ac.uk.
• Postgrad Med J. 2021 Dec 1; 97 (1154): 764-776.

Purpose Of The StudyTo 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 DesignObservational study using data from the UK Medical Education Database for 2140 doctors sitting the CASC for the first time between 2013 and 2018.ResultsAfter 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.ConclusionsSubstantial 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.© Author(s) (or their employer(s)) 2021. No commercial re-use. See rights and permissions. Published by BMJ.

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