PLAB and UK graduates' performance on MRCP(UK) and MRCGP examinations: data linkage study

Abstract

Objectives To assess whether international medical graduates passing the two examinations set by the Professional and Linguistic Assessments Board (PLAB1 and PLAB2) of the General Medical Council (GMC) are equivalent to UK graduates at the end of the first foundation year of medical training (F1), as the GMC requires, and if not, to assess what changes in the PLAB pass marks might produce equivalence. Main outcome measures Performance at MRCP(UK) Part 1, Part 2, and PACES assessments, and MRCGP AKT and CSA assessments in relation to performance on PLAB1 and PLAB2 assessments, as well as to International English Language Testing System (IELTS) scores. MRCP(UK), MRCGP, and PLAB results were analysed as marks relative to the pass mark at the first attempt. DesignResults PLAB1 marks were a valid predictor of MRCP(UK) Part 1, MRCP(UK) Part 2, and MRCGP AKT (r=0.521, 0.390, and 0.490; all P<0.001). PLAB2 marks correlated with MRCP(UK) PACES and MRCGP CSA (r=0.274, 0.321; both P<0.001). PLAB graduates had significantly lower MRCP(UK) and MRCGP assessments (Glass's Δ=0.94, 0.91, 1.40, 1.01, and 1.82 for MRCP(UK) Part 1, Part 2, and PACES and MRCGP AKT and CSA), and were more likely to fail assessments and to progress more slowly than UK medical graduates. IELTS scores correlated significantly with later performance, multiple regression showing that the effect of PLAB1 (β=0.496) was much stronger than the effect of IELTS (β=0.086). Changes to PLAB pass marks that would result in international medical graduate and UK medical graduate equivalence were assessed in two ways. Method 1 adjusted PLAB pass marks to equate median performance of PLAB and UK graduates. Method 2 divided PLAB graduates into 12 equally spaced groups according to PLAB performance, and compared these with mean performance of graduates from individual UK medical schools, assessing which PLAB groups were equivalent in MRCP(UK) and MRCGP performance to UK graduates. The two methods produced similar results. To produce equivalent performance on the MRCP and MRGP examinations, the pass mark for PLAB1 would require raising by about 27 marks (13%) and for PLAB2 by about 15-16 marks (20%) above the present standard.Conclusions PLAB is a valid assessment of medical knowledge and clinical skills, correlating well with performance at MRCP(UK) and MRCGP. PLAB graduates' knowledge and skills at MRCP(UK) and MRCGP are over one standard deviation below those of UK graduates, although differences in training quality cannot be taken into account. Equivalent performance in MRCGP(UK) and MRCGP would occur if the pass marks of PLAB1 and PLAB2 were raised considerably, but that would also reduce the pass rate, with implications for medical workforce planning. Increasing IELTS requirements would have less impact on equivalence than raising PLAB pass marks.

Predicting fitness to practise events in international medical graduates who registered as UK doctors via the Professional and Linguistic Assessments Board (PLAB) system: a national cohort study

“…These effects seemed independent of the other variables. Previously, it has been shown that performance at both the IELTS English language test and PLAB exams predicts later achievement in postgraduate medical training in international medical graduates [11, 12]. Likewise, we found that aspects of performance on the PLAB test was predictive of both the likelihood of referral and eventual censure.…”

Prevalence of GMC performance assessments in the United Kingdom: a retrospective cohort analysis by country of medical qualification

“…Poorer performance of IMGs in postgraduate examinations in the UK has been reported in numerous studies when compared to UK graduates [17, 18]. We also know that IMGs are more likely to be complained about to the GMC and receive more severe disciplinary action than other doctors in Fitness to Practise investigations [19, 20].…”

Licensing exams and judicial review: the closing of one door and opening of others?

“…Board (PLAB) exam before applying for GP specialty training. Two recent studies looking at the predictive validity of the PLAB exam in relation to MRCP and the MRCGP outcomes, 3 and Annual Review of Competence Progression outcomes in a variety of medical specialties 5 have concluded that the current standard of PLAB is set too low, and is below the competency level expected for a UK graduate completing foundation Year 1 training. Doctors who are not equivalent at entry to GP specialty training are likely to struggle with the MRCGP unless they receive training that addresses their specific needs.…”

“…Those differentials also exist in other postgraduate and undergraduate examinations. 2,3 In the light of these differential pass rates a judicial review of the RCGP and the GMC was requested by the British Association of Physicians of Indian Origin (BAPIO). The basis for the review were three claims: that the RCGP and GMC did not comply with their public sector equality duty (PSED), that the CSA directly discriminates against IMG and BME candidates, and that the CSA indirectly discriminates against IMG and BME candidates.…”