The BMJ Today: Respect for international doctors

A cluster of recent articles on concern the educational performance of international medical graduates compared with UK graduates. The subject has been hotly debated since the 1980s when it emerged that international medical graduates and doctors from ethnic minorities had disproportionately high failure rates in membership exams compared with UK graduates.

Two new studies commissioned by the General Medical Council find that international graduates achieve less satisfactory outcomes than UK graduates at annual appraisals, and that they perform less well than UK graduates in postgraduate examinations in internal and family medicine.

The GMC is considering revising the two examinations set by the Professional and Linguistics Assessment Board (PLAB Part 1 and PLAB Part 2) that determine whether an international graduate can obtain medical registration in the UK.  The BMJ studies find that performance in PLAB exams predicts future performance in professional assessments, and that international graduates who do better at compulsory English language tests do better in postgraduate training.

An editorial by Ed Peile unpicks the findings and suggests how the system needs to change. Respect for international doctors should be reflected in a fair process which evaluates their performance. Current PLAB assessments do not ensure equity between international and UK graduates, meaning that “the reputation of PLAB suffers, along with that of international graduates registered in the UK by this route.” He argues that, despite early support for international graduates, the system is automatically setting them up to fail.

Several readers have joined in the debate by sending rapid responses. Olumide Gbolahan reflects Ed Peile’s view that the current process is setting up international graduates to fail: “Allowing the current situation to persist where international medical graduates are allowed into the country but not allowed to train and update their skills undermines its ability to take on this responsibility. This is a dangerous situation that needs to be looked into.”

Another responder, Vipin Zamvar, says that his department (Cardiothoracic surgery, Edinburgh) is heavily reliant on locums and that all of these have been foreign graduates. This reflects the situation in the NHS as a whole, and many departments would not be able to function without a regular supply of foreign doctors. Therefore, he says, it is the responsibility of the NHS to provide significant extra resources for the education and training of foreign doctors who pass PLAB and work in non-training jobs. The reason for doing this is just not to help the foreign doctors, but more importantly because the NHS hospitals and patients will be relying on these doctors in future years.

Giselle Jones is specialist reviews editor, BMJ