Racial bias likely influenced RACP exam results finds review

3 minute read


The RACP has apologised to impacted candidates and accepted all 18 recommendations from the review into the college’s paediatric clinical examinations.


An independent review has concluded that unconscious bias, including racism, likely influenced the outcomes of the Royal Australasian College of Physicians’ clinical exams across New Zealand and Australia.

Commissioned by the RACP in 2023, the review, chaired by Maria Dew, followed more than 40 complaints made to the college about the clinical examination process for paediatric trainees.

The complaints related primarily to the 2021 Aotearoa New Zealand Paediatric Clinical Examination, including concerns over racial bias from examiners, and subsequent delays in addressing said complaints.

The review found that the subjective nature of some assessments and lack of specific guidance for examiners contributed to variations in how candidates were treated.

“Based on the evidence presented from participants and the acceptance of structural bias in the health sector more generally, we are satisfied that unconscious bias including racism did likely exist in the clinical examination processes in both Aotearoa New Zealand and Australia in 2021 and other years,” noted the review.

Both the Australian and the Aotearoa New Zealand trainee committee chairs told the review that they advised candidates from ethnic minority backgrounds to adopt a “western mind set” in order to pass clinical exams.

“The chairs explained that the fact that they felt it necessary to give this advice was evidence to them, that they were reacting to existing unconscious bias displayed by examiners,” read the report.

The chairman of the Māori health committee said, “it would be nice not to have to feel that we need to behave in a different way to not be negatively biased against”.

The review also confirmed that there were delays from the college in addressing trainee complaints relating to the examinations and a lack of avenues to appeal results across both Australia and New Zealand.

The review did note that dissatisfaction with the 2021 exams was heightened by pressures on the health system due to covid, but that existing concerns with the exams were present before this time.

It recognised a lack of diversity among the examiners and noted that the college did not collect data on ethnicity and disability status of its examination candidates, which prevented it from effectively assessing bias and equity.

President of the RACP Professor Jennifer Martin acknowledged the significant impact of these findings.

“We acknowledge and apologise for the distress experienced by some candidates in the 2021 examination and the college commits to addressing the report’s findings, in particular those relating to the exam structure and unconscious bias, to improve transparency and equity,” she said.

The review made 18 recommendations, including implementing training to recognise and manage unconscious bias in examiners, revising the exam structure to include more objective criteria and contemporary practice and ensuring diversity within the examiner panels.

The review also suggested facilitating Australian examiners to travel to Aotearoa New Zealand, or Aotearoa New Zealand candidates to travel to Australia, to help reduce the risk of conflict due to the candidate being known to the examiners.

The RACP has committed to implementing changes, accepting all 18 recommendations, and appointed a working group tasked with implementation.

It noted that some actions have already been taken to tackle unconscious bias among examiners, such as training introduced in 2023, and would be built upon going forward.

Professor Martin said the college was treating the findings of the report with “the utmost seriousness”.

“Training colleges such as ours should promote an inclusive and culturally safe environment for the next generation of specialists – we are committed to making the necessary changes to ensure that is the case,” she said.

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