Fairness of decisions to refer doctors to the MPTS interim orders tribunal

What were the key findings?

The research involved a pilot experimental study and qualitative interviews. 

The pilot experimental study

  • The pilot aimed to test whether an experimental design would be a practical way of exploring the key research question: whether GMC case examiner decisions were influenced by the ethnicity or country of primary medical qualification (PMQ) of doctors under investigation when referring doctors to an interim orders tribunal (IOT). Unfortunately, the practical difficulties involved in redacting and falsifying cases made it impossible to progress to a full study with a large number of cases due to required resources.
  • Because of the small number of cases the findings of the pilot lack statistical reliability.  
  • Within the pilot, GMC case examiners referred similar proportions of BME UK graduates but slightly fewer white UK graduates than the comparison group of decision makers. GMC case examiners also referred slightly fewer non-UK doctors than the comparison group, but referred similar proportions of UK graduates. These results were weakly statistically significant, and were no longer so after a statistical correction (the correction can sometimes result in the rejection of a truly significant result and should be treated with caution).
  • In summary, no definite conclusion can be reached on the basis of the pilot’s findings.

The qualitative interviews

The qualitative phase of the research identified clear evidence of good practice in case examiner training and the guidance provided to case examiners.

Drawing on the wider psychological literature regarding decision making, the qualitative research identified that GMC case examiners used systemic processing when writing their justification.

There was also evidence of the use of heuristic processing in the decision making of GMC case examiners. However, this was in keeping with their guidance and training.

From the qualitative interviews there was no evidence that any IOT referral differences with respect to ethnicity or PMQ were due to bias on the part of the GMC case examiners.

Why did we commission this research?

This research is part of an ongoing programme of work to make sure our fitness to practise procedures are fair, consistent and robust. This includes statistical analysis of our data and audits of our decisions. The pilot explored whether an experimental approach could provide further assurance. 

What did the research involve?

The researchers recruited independent ‘case examiners’ to re-take decisions already undertaken by GMC staff on the basis of the same evidence. It should be noted that it wasn’t practically possible to recruit the independent case examiners to the same criteria (e.g. qualifications, background) that the GMC use for recruiting its case examiners. Results were then compared between the decisions of the GMC’s case examiners and those of the independent case examiners. GMC case examiners were also interviewed regarding their approach to decision making. 

Full report 

Download Fairness of decisions to refer doctors to the Medical Practitioners Tribunal Service interim orders tribunal