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UK tests for overseas doctors - performance linked to future risk of malpractice

Posted on 20 March 2017

Restricting the number of times international medical graduates (those who qualified outside the European Economic Area) can resit competency tests may help protect patients from future malpractice, a study by the University of York has concluded.

Image of doctor

The study looked at a cohort of international medical graduates who had registered with the General Medical Council’s (GMC) Professional and Linguistic Assessment Board (PLAB) test, and discovered that those who had to sit the PLAB several times were more likely to get sanctioned for fitness to practise later.

Before they can be registered with the GMC, doctors from outside of the UK and European Economic Area have to show they can speak fluent English and have the necessary medical knowledge and skills to work safely in our health service.

The authors of today’s report note that, since last year, the GMC has made substantial changes to the PLAB test and the report’s findings relate to a previous cohort of candidates.

Over the seven year study period (2006 to 2012 inclusive) 215 international medical graduates received some form of sanction (including a warning from the GMC).  This represented approximately 0.8 per cent of that group of doctors in the sample. However, this rate is roughly twice that of UK graduates (0.4per cent).

Around 60 per cent of overseas doctors (those not from the EU) pass both parts of the PLAB at first attempt.  The authors of the study estimate that if medical registration were limited to these candidates then the rate of sanctions for fitness to practise would have halved in that group of doctors over the study period.

However, this measure is unlikely to be acceptable to candidates or employers given the workforce issues the NHS is facing in certain specialist areas.

PLAB test

The report authors suggested that if part one of the PLAB test (a test of medical knowledge) had been restricted to a maximum of three sittings then the rate of sanctions in relation to fitness to practise in the study sample of doctors would have been reduced by approximately eight per cent. Restricting it to four would have made little impact as very few of the doctors studied had needed to resit either part of the test three times. 

Lead researcher, Dr Paul Tiffin, from the University of York’s Department of Health Sciences, said: “From September 2017 the GMC will impose a limit of four sittings at most for both parts of the PLAB.

“However, we estimated that this measure, would not have, in itself, in isolation, have substantially reduced the rate of sanctions in this previous group of doctors.  

“The numbers are small but just one incompetent doctor can cause a disproportionate amount of problems.

 “Our findings suggest that further limiting the number of resits permitted may help protect patients from malpractice.

“We also note that, since last year, the GMC has made some key changes to increase the focus of the exam on a candidate’s understanding of ethics and professionalism, by now including scenarios in part two of the test that evaluate this.

 “Evaluating these aspects of a doctor’s skills and knowledge is essential as most sanctions are received in relation to breaches of professionalism, rather than clinical performance. ”

The authors of the report say the findings will be important to consider when the GMC introduces its intended UK Medical Licensing Assessment (UKMLA) that all doctors who wish to work in the UK will have to pass.

Support measures

Some  support measures, such as the GMC run ‘Welcome to UK Practice’ programme, are already available. The authors also suggest that other interventions, such as local induction and shadowing programmes should be extended and widely implemented to help overseas graduates make the transition to working in UK health services.

The researchers suggest that such steps may also reduce the risk of non-UK doctors being subjected to the stress related to official complaints which ultimately prove groundless.

The study was funded by the GMC and published in the journal BMC Medicine.

Contact details

Alistair Keely
Head of Media Relations

Tel: +44 (0)1904 322153

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