UK ethnic minority doctors are four times more likely than white candidates to fail their clinical GP exam, the General Medical Council has found.
The review into 5,000 candidates was ordered after ethnic minority students complained the exam was unfair.
Prof Aneez Esmail, an expert on racism in the NHS who led the investigation, said he could not exclude racial discrimination as the cause.
But the Royal College of GPs, which sets the exams, denies they are unfair.
RCGP chairwoman Dr Clare Gerada said the college took equality and diversity issues "extremely seriously".
She added that the college: "strongly refutes any allegations that the exam is discriminatory in any way".
Dr Gerada said: "The review found no evidence of discrimination, and in fact what it showed was that it was probably preparedness for the exam that was a factor.
"We already take comprehensive steps to ensure that the exam is fair and equitable to all candidates."
"This exam is designed for doctors to practise independently; it is not an exam that has to be passed by everyone. I think that is a very important issue.
"Of course we cannot be complacent and we continue to make sure the exam does not have bias built in."
All trainee GPs must pass the Clinical Skills Assessment (CSA) before they can practise as a GP.
It is a practical test introduced in 2010 in which trainees are assessed by an examiner while they treat actors in a mock-surgery setting.
Doctors are allowed to have up to four attempts at the test.
'Reduce bias'During the six-month review for the GMC, Prof Esmail analysed data on more than 5,000 candidates who sat the CSA exam over a two-year period.
Prof Esmail said: "The British ethnic minority graduates have undergone the same training and yet by the mere fact that they are an ethnic minority, they appear to be failing four times more often than their white colleagues.
"That's why I say we cannot exclude racial discrimination."
He added: "Let's acknowledge that there is a problem and put in place something that can reduce that bias."
End Quote Asif Mahmood Trainee GPThe whole process has set me back in my career by at least 18 months and has hit me financially too"
Asif Mahmood, 30, a British-trained doctor from Burnley, failed the CSA exam four times.
"It was very difficult not passing the exam, I know my parents were very upset and I was just embarrassed that I kept failing," he said.
Each trainee has only four attempts to pass the exam, after which they are typically removed from the GP training programme.
Asif finally passed the exam on his fifth attempt, after appealing to the RCGP when he failed on his fourth attempt.
"The whole process has set me back in my career by at least 18 months and has hit me financially too," he said.
The GMC review also found differences in the pass rates for foreign-trained doctors, with trainee GPs from abroad 14 times more likely to fail the CSA exam than white British doctors.
Organisations representing ethnic minority doctors have threatened legal action against the RCGP.
Dr Ramesh Mehta, President of the British Association of Physicians of Indian Origin (BAPIO) said: "Hundreds of doctors' careers have been damaged because they have repeatedly failed the CSA exam.
"They are facing institutional bias and are unfairly failing the exam despite extensive training and knowledge."
Case for actionBAPIO has been given permission to launch a judicial review against the RCGP and the GMC over the exam.
"We want the exam to be suspended until the outcome of the review," said Dr Mehta.
But Prof Esmail said the CSA was an important assessment and necessary to assess the competence of doctors.
"I think the exam itself is a well tried and tested method to see how safe trainees are to practise.
"But there are a number of things we can do to make it fairer," he said.
He has made a number of recommendations to try to combat bias in the exam.
His recommendations include having more examiners and actors who are from ethnic minority backgrounds.
The GMC said it was taking the findings of the independent review seriously.
Niall Dickson, chief executive of the General Medical Council, said: "We agree with Prof Esmail that there is no room for complacency - we want to work with him and all those involved in this area.
"We are duty-bound to act where there is evidence of a problem and his report and recommendations make a powerful case for action."
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