Racial discrimination and the preregistration exam

Preregistration pharmacists are probably breathing a deep sigh of relief after their examinations finished in June 2018. Even for the most prepared of candidates, this exam is never easy — perhaps rightly so.

However, a paper presented to the General Pharmaceutical Council (GPhC) on 12 July 2018 reveals there may not be a level playing field for all candidates. It showed large differentials in pass rates for particular groups — with significantly worse pass rates for older candidates, those training in the community and those taking the exam multiple times — but it is the “marked difference in performance by ethnicity” highlighted in the paper which is most disturbing.

For many years, black candidates have had the lowest pass rate of all ethnicities in the preregistration exam. Results from the 2017 cohort showed a pass rate of 94% for white candidates and 90% for Chinese candidates, but 66% for black candidates and 72% for candidates with Pakistani ethnicity.

This is a complicated issue and differences in pass rates are not, in themselves, proof of anything more sinister. However, on 5 February 2016, a GPhC-commissioned report looked into this problem and it did find some possible explanations.

The report revealed that black students were more likely to be mature students, with family or other commitments, and they were also more likely to have undertaken part, or all, of their secondary school education overseas.

More worryingly, there were also reports of “explicit prejudice and perceptions of implicit bias” against black students in the report and “feelings of isolation and exclusion” during their studies. Black candidates are often a small minority in their school of pharmacy alongside large cohorts of Asian and white students, which can lead to difficulties in forming study groups or supportive peer networks.

Racial disparities are not just a problem for the preregistration exam — the entrance exam for GPs was also recently embroiled in a judicial review over the lower pass rates for black and minority ethnic (BME) candidates, compared with their white peers. This legal action was lost, although the Royal College of General Practitioners has still been working with international doctors’ groups on ways to support BME candidates better, offering more preparation courses and attempts at the exam.

The GPhC has said it will take three actions in the light of the disparities it has uncovered: requiring pharmacy schools to be more “proactive” in their policies on equality and diversity, including this in its accreditation events and talking with education providers to evaluate their policies in this area.

The regulator deserves praise for highlighting this as an issue, although questions must be asked about why it has taken two years for any action to be taken to address it. Tweaking policy documents may be the right initial response, but it may take more to make a material difference to the experience of black candidates taking the preregistration exam and ensure it is fair and beyond reproach.

Pharmacy must draw talent from the widest pool of candidates and clearly it is not right that some subsections of the population seem to be getting a raw deal. The Pharmaceutical Journal urges the GPhC to do all it can to ensure that all candidates are supported to achieve their full potential.