title: Cross-comparison of MRCGP & MRCP(UK) in a database linkage study of 2,284 candidates taking both examinations: assessment of validity and differential performance by ethnicity.
abstract: BACKGROUND
  MRCGP and MRCP(UK) are the main entry qualifications for UK doctors entering general [family] practice or hospital [internal] medicine. The performance of MRCP(UK) candidates who subsequently take MRCGP allows validation of each assessment. In the UK, underperformance of ethnic minority doctors taking MRCGP has had a high political profile, with a Judicial Review in the High Court in April 2014 for alleged racial discrimination. Although the legal challenge was dismissed, substantial performance differences between white and BME (Black and Minority Ethnic) doctors undoubtedly exist. Understanding ethnic differences can be helped by comparing the performance of doctors who take both MRCGP and MRCP(UK).
  
  
  METHODS
  We identified 2,284 candidates who had taken one or more parts of both assessments, MRCP(UK) typically being taken 3.7 years before MRCGP. We analyzed performance on knowledge-based MCQs (MRCP(UK) Parts 1 and 2 and MRCGP Applied Knowledge Test (AKT)) and clinical examinations (MRCGP Clinical Skills Assessment (CSA) and MRCP(UK) Practical Assessment of Clinical Skills (PACES)).
  
  
  RESULTS
  Correlations between MRCGP and MRCP(UK) were high, disattenuated correlations for MRCGP AKT with MRCP(UK) Parts 1 and 2 being 0.748 and 0.698, and for CSA and PACES being 0.636. BME candidates performed less well on all five assessments (P < .001). Correlations disaggregated by ethnicity were complex, MRCGP AKT showing similar correlations with Part1/Part2/PACES in White and BME candidates, but CSA showing stronger correlations with Part1/Part2/PACES in BME candidates than in White candidates. CSA changed its scoring method during the study; multiple regression showed the newer CSA was better predicted by PACES than the previous CSA.
  
  
  CONCLUSIONS
  High correlations between MRCGP and MRCP(UK) support the validity of each, suggesting they assess knowledge cognate to both assessments. Detailed analyses by candidate ethnicity show that although White candidates out-perform BME candidates, the differences are largely mirrored across the two examinations. Whilst the reason for the differential performance is unclear, the similarity of the effects in independent knowledge and clinical examinations suggests the differences are unlikely to result from specific features of either assessment and most likely represent true differences in ability.
authors.affiliation: Hughes Hall, University of Cambridge, Cambridge, CB1 2EW, UK. rew5@cam.ac.uk.
authors.forename: Richard
authors.initials: R
authors.lastname: Wakeford
authors.affiliation: Royal College of General Practitioners, 30 Euston Square, London, NW1 2ED, UK. mldenney@btinternet.com.
authors.forename: MeiLing
authors.initials: M
authors.lastname: Denney
authors.affiliation: UCL Medical School, University College London, Gower Street, London, WC1E 6BT, UK. katarzyna.ludka.10@ucl.ac.uk.
authors.forename: Katarzyna
authors.initials: K
authors.lastname: Ludka-Stempien
authors.affiliation: UCL Medical School, University College London, Gower Street, London, WC1E 6BT, UK. j.dacre@ucl.ac.uk.
authors.forename: Jane
authors.initials: J
authors.lastname: Dacre
authors.affiliation: UCL Medical School, University College London, Gower Street, London, WC1E 6BT, UK. i.mcmanus@ucl.ac.uk.|Research Department of Clinical, Educational and Health Psychology, University College London, Gower Street, London, WC1E 6BT, UK. i.mcmanus@ucl.ac.uk.
authors.forename: I C
authors.initials: IC
authors.lastname: McManus
mesh_terms: D044383:Black People / Q000193:education / Q000706:statistics & numerical data; D002983:Clinical Competence / Q000592:standards* / Q000706:statistics & numerical data*; D016208:Databases, Factual; D004503:Education, Medical, Graduate / Q000592:standards* / Q000706:statistics & numerical data*; D005006:Ethnicity / Q000193:education* / Q000706:statistics & numerical data*; D058006:General Practice / Q000193:education* / Q000592:standards*; D064416:Hospital Medicine / Q000193:education* / Q000592:standards*; D006801:Humans; D007388:Internal Medicine / Q000193:education* / Q000592:standards*; D008913:Minority Groups / Q000193:education / Q000706:statistics & numerical data; D063505:Racism; D013044:Specialty Boards / Q000706:statistics & numerical data*; D013222:State Medicine; D013223:Statistics as Topic; D006113:United Kingdom; D044465:White People / Q000193:education / Q000706:statistics & numerical data