Tackling bias when we make decisions

Andrea Callender, the GMC’s Head of Diversity, talks about her work to deliver unconscious bias training to staff to make sure our decisions about doctors are fair and asks if there’s more we should be doing to stamp out bias. 

As a regulator, we have to make various decisions about doctors. It is at the core of our work:

  • We determine which doctors are qualified to work here.
  • We oversee medical education and training in the UK, which involves us ensuring that the bodies involved in this area are also making fair and robust decisions about students and doctors in their examinations and assessments.
  • We decide whether a doctor’s fitness to practise is impaired.
  • We make revalidation decisions about a doctor, based on evidence and the recommendation of their responsible officer.

As a regulatory body, our functions and the way that we carry them out are set in law, so in making decisions such as whether a doctor can be registered, we have to follow a tight legislative framework. Some procedures and processes might appear to treat some doctors differently, but they are consistent with our legal obligations. For example, our registration procedures are different for doctors who qualify overseas.

We have taken a number of steps over the years to ensure that decisions are objective, consistent and based on our standards and guidance.

We make decisions at a number of levels, and in a number of ways. For example, we review a considerable amount of documentary evidence when deciding whether a doctor should be granted a licence to practise. We conduct assessments, like PLAB, which involve independent associates making judgements about a doctor’s clinical skills. We review information from employers and patients to decide whether a concern raised about a doctor, for example, about their health or performance, should proceed to the next level of our investigation process.

Keeping a vigilant eye on bias

The Oxford Dictionary defines bias as ‘inclination or prejudice for or against one person or a group, especially in a way that might be considered unfair’.

Research has identified several types of bias that can influence our thinking. Making decisions based on bias (unconscious or otherwise) can lead to outcomes that are unfair, and we are frequently asked to prove that we aren’t biased in how we deal with certain individuals and groups of doctors. We have taken a number of steps over the years to ensure that decisions are objective, consistent and based on our standards and guidance.

Andrea Callender discusses unconscious bias at the GMC Conference 2015

Andrea Callender (pictured right) discusses unconscious bias at the GMC Conference 2015

Our fitness to practise procedures come under particular scrutiny, which is why last year we published the results of the latest review of decision making at the investigations stage. The independent review found that decisions in all of the cases looked at were appropriate, and no evidence of bias in the wording of our guidance that might account for the over-representation of certain groups in our procedures.

Giving staff the tools to make fair decisions

Last year we went a step further by rolling out a programme of unconscious bias training to 200 staff who make decisions about doctors across the GMC. This is something that many UK organisations are doing, and we felt that it was important for our staff to reflect on how we make decisions that can have significant consequences for individual doctors, patients, and the wider community.

Staff were open about the need to guard against making any assumptions about a doctor, and to build in time to carefully weigh up information and provide clear reasons for decisions.

Staff were open about the need to guard against making any assumptions about a doctor, and to build in time to carefully weigh up information and provide clear reasons for decisions.

Has the issue gone away now that we have delivered the training? No it hasn’t and we have to remain vigilant:

  • Last year’s training has evolved into a programme of work looking at decision-making, including some research to develop our understanding of how other organisations ensure that their decisions are fair.
  • We’ve incorporated discussions about managing bias into the training of our medical and lay associates, including MPTS tribunal members.
  • We’re constantly reviewing and updating our guidance for staff and associates involved in making decisions about doctors.
  • A new interactive online tool guides doctors in making decisions about a patient’s mental capacity, based on the principles in our guidance on consent and end of life care.
  • Later this year we will publish this year’s progression data, bringing together the information we collect from medical royal colleges and postgraduate training bodies about the pass rates of the assessments they set doctors.

Are there things we should be doing that we haven’t considered? Please share your ideas with us in the comments section below.

Related posts

Andrea Callender reports on our conference on the challenges and opportunities of being fair

Anthony Omo, the GMC’s Director of Fitness to Practise and General Counsel, writes about our work to improve investigations for doctors and patients

The GMC’s Head of Diversity blogs about about how doctors can help us understand even more about the diversity of the medical profession.

4 responses to “Tackling bias when we make decisions

  1. Pingback: Round up: Brexit, learning from incidents & tackling bias – Good doctors·

  2. Andrea and the team and GMC has come a long way and should be proud of many changes GMC has made to make sure the internal process and systems are fair and all doctors are treated well and GMC does get it right most of the time.

    The changed proposed and already made by GMC will go long way to make sure professional regulation is fair and proportionate as far as GMC is concerned.

    Sad reality is GMC is only the tip of the iceberg of bias and subconscious bias. Most of the bias takes place locally at the level of Trust and CCG where sad reality is club culture, old boys’ network are rife. Culture of bullying, discrimination, subconscious bias, racism are rife and in such a culture patients and staff suffer. Cover up is common in such a culture.

    Organisations like BAPIO (www.bapio,co,uk) and BIDA (www.bidaonline.co.uk) have been raising our concerns for quite some time with the authorities, GMC, NCAS and BMA. Sad reality is progress on this has been very slow.

    Fortunately with BAPIO legal challenge there have been some improvement in exam results but professional regulation at the level of the Trust and CCG are still not fit for the purpose. MHPS and RO legislation are often not used well or misused. In such a culture patient safety and staff well-being is compromised. BME staff and Whistleblowers continue to suffer. Nearly three years on from Francis report, progress on BME issues and Whistle-blowers have been very slow. Hopefully Workforce Race Equality Scheme (WRES), Revalidation and GMC’s determination to get professional regulation right gives me lots of hopes so that one day we can all be proud of professional regulation which truly protects patients and supports doctors and very tiny number of doctors are disciplined and dealt properly and as a profession we can be proud of professional regulation.

    I have written this comment only as BIDA Executive Committee member and as overseas doctors’ mentor and not in any other capacity.

    • I have written to the Head of the GMC about my concerns about the two tier standard of Consultant Haematologists in the UK. Onse set fully trained with MRCP and MRCPath and the other with improper training making dangerous decisions on patients. I also wrote to the Royal College of pathologists about it.They say it is the GMC who mandates that these doctors practice as Consultant Haematologists in the UK. I have not received a satisfactory response
      The only light at the end of the tunnel may be that Brexit will not allow this to continue
      A recent BBC panorama Radio 4 programme by Tom Urey journalist highlighted some of the problems. What is the GMC going to do about changing this?

  3. Pingback: Fair training pathways: understanding differential attainment in medicine | General Medical Council·

Leave a comment

Fill in your details below or click an icon to log in:

WordPress.com Logo

You are commenting using your WordPress.com account. Log Out / Change )

Twitter picture

You are commenting using your Twitter account. Log Out / Change )

Facebook photo

You are commenting using your Facebook account. Log Out / Change )

Google+ photo

You are commenting using your Google+ account. Log Out / Change )

Connecting to %s