Terence Stephenson: Medical licensing assessment will keep us ahead of the field

The GMC is consulting on plans to develop a medical licensing assessment (MLA) that will assure and showcase the quality of medical education and practice across the UK.

The thinking behind a single objective assessment for those wishing to practise medicine in the UK stems from current piecemeal arrangements. These not only provide differing levels of assurance about those joining the register, but also offer no way of knowing if different groups are being treated fairly.

Every one of the UK’s 32 medical schools has its own system. Even though they share some written questions, evidence is emerging about the variation in medical schools’ finals and there is no UK wide process to set a common standard to pass. Yet before medical school, all GCSE and A-level exams are set and marked nationally, and after medical school, all postgraduate exams are set and marked nationally. So local undergraduate exams are the exception. If your driving test was marked by your own instructor, it would be really odd.

International medical graduates also have several means of entry—the best known of which is the GMC’s PLAB test, recently reviewed and strengthened [1]. Finally, doctors from the European Economic Area (EEA) can currently secure a UK licence to practise without any test of their competence.

This patchwork of entry routes to UK practice is inherently unfair to doctors, and is understandably something of a surprise to patients. A recent poll of patients [2] found that two thirds would have greater confidence in the checks carried out on doctors if there was a single assessment to enter the profession.

That’s not to argue that current UK medical school education is deficient. There is a wealth of evidence that graduates from UK medical schools do well here and when they work overseas [3]. However, current arrangements do not allow us to determine a common threshold of competence for all graduates seeking the same licence to practise in the UK.

At the same time there is evidence of disparity between medical schools in how prepared UK graduates are for practice [4]. We need doctors who are confident enough to inject patients, take blood, insert intravenous drips—some quite invasive procedures—and if they don’t feel confident to do those things they need us to support them.

The Secretary of State for Health recently unveiled proposals to increase medical student numbers in England by 1500 [5]. New medical schools are appearing in England. Plus the UK’s decision to leave the European Union may make it possible to test EEA doctors’ knowledge and skills to practise here alongside UK candidates and doctors from the rest of the world. In the meantime, we will continue to work within the limitations of UK law to ensure all doctors practising medicine in the UK are fit to practise. But if ever there was a moment to look at how we can improve assurance for patients that standards at entry are consistent, this is surely it.

Our challenge then is to create with the expertise of our medical schools an objective threshold for those seeking to enter UK medicine. It must be an assessment with demonstrable validity; giving confidence to applicants that they will be assessed as meeting an agreed threshold for licensing, and creating a kitemark of international standing that indicates the high standard of UK medical training.

The goal must be to create an assessment that not only focuses on the essential knowledge and clinical skills needed for practice, but which also tests the professional and communication capabilities of graduates, which will be so vital if we are to develop the adaptable “thinking doers” who will lead the profession and four country healthcare systems in future.

Regulators are frequently accused of imposing new requirements without regard to the additional burden they will create. We are acutely aware of those concerns, and will ensure that the overall burden of assessment is not excessive.

If implemented this new system would create a transparent process that demonstrates to students, funders, the healthcare system, and—crucially—patients that graduates, wherever they have qualified, are meeting the licensing threshold.

While developing the new assessment as the principal and default means of obtaining a licence to practise in the UK, we will review and in due course consult on the various ways in which senior, experienced, and fully trained international medical graduates can acquire registration with a licence to practise.

Introducing a new assessment will take some years to achieve and we can only do this by working closely with our partners and by harnessing the extensive expertise in assessment. But, after visiting every medical school in the UK last year, we see growing confidence that we can create something that will become a marker of the excellence of UK medical education and UK medicine around the world.

The General Medical Council’s consultation on the medical licensing assessment is open until 30 April. To read the proposals and give your views, visit http://www.gmc-uk.org/education/30516.asp.

Terence Stephenson, chair, General Medical Council.

Competing interests: Prof Stephenson is the chair of the General Medical Council (2015-18), which supports the introduction of a single medical licensing assessment.


[1] GMC, PLAB test changes, August 2016 http://www.gmc-uk.org/doctors/plab.asp

[2] MLA survey for GMC, Populus Research, November 2016

[3] GMC, The State of Medical Education and Practice in the UK, November 2016 http://www.gmc-uk.org/publications/somep2016.asp

[4] GMC State of Medical Education and Practice, 2014 http://www.gmc-uk.org/SoMEP_chapter_3.pdf_58053779.pdf

[5] “Up to 1,500 extra medical training places announced,” Department of Health https://www.gov.uk/government/news/up-to-1500-extra-medical-training-places-announced