'I'm angry and sad': why one IMG doctor is leaving emergency medicine for the RACGP

Dr Namal Prematillake is one of 34 doctors who lodged a complaint of racism against the emergency medicine college.
hard exam

After nearly a decade as an emergency medicine registrar, Dr Namal Prematillake now plans to train as a GP.

The Sri Lankan-born doctor is one of the 34 IMGs who lodged an anonymous complaint with the Australian College of Emergency Medicine (ACEM) in January, accusing it of systemic racism against “non-white” doctors in the marking of its final clinical exam for fellowship.

It has become the latest and most prominent spat between a specialist medical college and IMGs over concerns about their treatment and support as they work towards fellowship.

Dr Prematillake said when the emergency medicine fellowship clinical exam — a physical role-play conducted with actors — was restructured in 2015 to give examiners greater latitude over marking, the scores of “non-white” doctors fell off a cliff compared with “whites”.

An internal ACEM investigation, launched by the college in response to the claims, seems to substantiate their main accusation.

In an interim report summary released in June, the college’s investigators wrote that the 2015 changes to its final clinical exam “may have unintentionally given rise to a systemic racial discrimination effect”.

That discrimination, they wrote, operated “principally through the mechanism of potential unconscious bias of examiners”.

Dr Prematillake, who has opted to go public on his experience,  says that isn’t good enough. 

He refers to data provided by ACEM to the Australian Medical Council in June as part of their re-accreditation application, which he says shows the full extent of the bias.

The college compared pass rates of its final clinical exam between doctors trained in Anglo-Saxon-majority countries, such as Australia, Canada and the UK, with those trained in the rest of the world.

According to the data, the two groups passed the final exam at an almost equal rate at every sitting until 2015, when the scores for the “rest of the world” group plummeted.


source: ACEM reaccreditation submission

Of the 204 candidates who attempted the second sitting of the clinical exam in 2016, nearly 70% of those trained in Anglo-Saxon countries passed. The figure for those from the rest of the world was closer to 10%.

The ACEM board is expected to be given the final report into the IMGs' complaint on Monday.

When they do, Dr Prematillake says, they should move beyond the language of “unintentional” and “unconscious” racism, because that implies blamelessness.

“I am angry and sad,” he tells Australian Doctor. “I wasted eight years and probably $100,000, while all that time spent studying I could have spent with my family.”

He says he is “absolutely certain” that he would have passed the clinical exam were it not for the colour of his skin.

“I need justice. The people running the college must accept that they failed, they discriminated against us, and they must apologise.”

When contacted by Australian Doctor last week, ACEM president Professor Tony Lawler declined to comment on any specific case, but said the college has acknowledged the need for “careful review and investigation” of the IMGs’ claims by setting up an expert advisory group to investigate.

“The outcomes of the expert advisory group’s work will be made public, as will the subsequent actions to be taken by the college,” he said.

That will be too late for Dr Prematillake, who resigned his ACEM membership in February and is applying to start GP training next year.

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