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Differential attainment in the MRCPsych according to ethnicity and place of qualification between 2013 and 2018: a UK cohort study
  1. Paul A Tiffin1,2,
  2. Lewis W Paton1
  1. 1 Mental Health and Addictions Research Group, Department of Health Sciences,, University of York, York, UK
  2. 2 Health Professions Education Unit, Hull York Medical School, York, UK
  1. Correspondence to Paul Tiffin, Department of Health Sciences, University of York & Health Professions Education Unit, Hull York Medical School, York Y0105DD, UK; paul.tiffin{at}


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.

  • Psychiatry
  • medical education & training

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  • Contributors PAT conceptualised the study and led on data analysis, interpretation and drafting the manuscript. LWP contributed to data analysis, interpretation and critically appraising the manuscript. Both authors approved the final version of the manuscript for submission.

  • Funding PAT is supported in his research by a National Institute for Health Research Career Development Fellowship. This paper presents independent research funded by the NIHR. The views expressed are those of the authors and not necessarily those of the University of York, NHS, the NIHR or the Department of Health and Social Care.

  • Competing interests None declared.

  • Patient consent for publication As the study used routinely collected, de-identified data, ethical approval was not required. This was confirmed in writing by the Chair of the University of York Health Sciences Ethics Committee. Moreover, individual informed consent for the use of the data was not required for this study. This is because all the data used were held within the UKMED. The use of personal data in UKMED is not reliant on individual consent from data subjects, as it is not a necessary condition for processing under the General Data Protection Regulation (GDPR), which allows personal data to be used without consent where it is necessary for statutory functions.

  • Ethics approval The Medical Act 1983 gives the GMC a legal responsibility to promote high standards of medical education and co-ordinate all stages of medical education. This enables the creation of the database and the disclosure of data by other providers in compliance with the GDPR. For more information see

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Data sharing statement Data are available upon reasonable request.

  • Data availability statement This study involved the analyses of secondary data. Access to the data may be obtained from the UK Medical Education Database (URL: following approval of an application. Code for data management and analysis is available from the lead author on request.