Unwin, E;
Woolf, K;
Dacre, J;
Potts, HWW;
(2019)
Sex differences in fitness to practise test scores: Cohort study of GPs.
British Journal of General Practice
, 69
(681)
e287-e293.
10.3399/bjgp19X701789.
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Abstract
Background Male doctors on average perform more poorly in clinical assessments compared to female doctors; and are more likely to be sanctioned. It is unclear why. Aims To examine sex differences in the assessment scores of General Practitioners (GP) under investigation by the General Medical Council (GMC), compared to GPs not under investigation; and whether scores mediate any relationship between sex and sanction likelihood. Design and setting Retrospective analysis of administrative Tests of Competence (ToC) GP data. ToC are written and clinical assessments taken by doctors under investigation by the GMC who have significant performance concerns, and a comparator group of volunteer doctors. Methods Analysis of variance to compare written and clinical ToC performance by sex and GP group (under investigation vs volunteers). Path analysis to explore the relationship between sex, written and clinical ToC performance, and investigation outcome. Results On the written test, women GPs under investigation outperformed men (Cohen’s d=0.28, P=0.01); there was no sex difference in the volunteer group (Cohen’s d=0.02, P=0.93). On the clinical assessment, women outperformed men in both GP groups (Cohen’s d=0.61, P<0.0001). Higher clinical score predicted remaining on the register without a warning or sanction; with no independent effect of sex controlling for assessment performance. Conclusion Women outperform men on clinical assessments, even among GPs with generally very poor performance. Male GPs under investigation may have particularly poor knowledge. Further work is required to understand potential sex differences in who takes the ToC and how this impacts on sex differences in investigation outcomes.
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