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The听large听data linkage听study, published听in听BMC听Medicine,听assessed听the exam results of UK registered doctors who had taken听knowledge based听exams听and clinical听assessments,听set by the MRCGP (Membership of the Royal College of General Practitioners)听or听the MRCP(UK) (Membership of the Royal Colleges of Physicians of the United Kingdom).听听

Researchers听linked听the听exam data听to听General Medical Council听(GMC) data听on听鈥楩itness to Practise鈥� (FtP)听sanctions against听medical听doctors, the most serious听of which听is being struck off or erased from the medical register;听other sanctions听range听from听suspension from the register听to听receiving a warning for very poor behaviour or performance.

The study found doctors sanctioned by the Medical Practitioners Tribunal Service (MPTS), which makes decisions independent of the GMC, had previously scored substantially lower听on both the knowledge and clinical skills assessments in MRCGP and MRCP听(UK), with clinical assessments predicting听sanctions听somewhat more strongly. Of importance, researchers found,听that each additional increment in knowledge or skill contributed to a reduced likelihood of later sanctions.

Co-author Dr Katherine Woolf (UCL Medical School)听said:听鈥淭his study is the first to demonstrate for UK doctors that听how well they perform in听postgraduate examinations听predicts听the听likelihood of their receiving a professional sanction, which could set back or, at worse, end their career.听听

听鈥淭he findings听demonstrate听that听postgraduate听examinations听measure听important high-level knowledge, skills, and attitudes, which听underpin听doctors鈥� real world behaviour.听The findings contradict the frequent assertion that听postgraduate medical examinations听are unrelated to doctors鈥� clinical practice.鈥澨�听

The听MRCP听(UK) and MRCGP听exams are central to ensuring the quality of听UK doctors in training to听become specialists in hospital care or general practice.听This research supports听the听value听of the examinations听in protecting patients.听听

Exam听results were obtained for UK registered doctors taking the MRCGP Applied Knowledge Test听(AKT;听27,561听doctors) or听Clinical Skills Assessment (CSA;听17,365) at first attempt between 2010 and 2016 or taking听MRCP听(UK) Part 1 MCQ (multiple choice questions;听37,358), Part 2 (MCQ;听28,285) or Practical Assessment of Clinical Examination Skills听(PACES;听27,040) at first attempt between 2001 and 2016.听听Exam data were听linked with GMC actions on a doctor听registration from September 2008 to January 2017.听

Doctors in the lowest 2.5% of exam performance were about 12 times more likely to have sanctions than those in the top 2.5%.听听听

Corresponding author Professor Chris McManus (UCL听Medical School) said:听鈥淔itness to practise is at the core of being a doctor - one of the most trusted and responsible positions in society听

鈥淒octors who are not fit to practise endanger patients and others, and the GMC is understandably strict about such matters, with conduct and trust at the heart of the GMC鈥檚 approach to Fitness to Practise.听听

鈥淗owever postgraduate examinations are primarily concerned about knowledge and skills, with the exams being set and administered by Royal Colleges, which are independent of the GMC.听

鈥�Our findings therefore suggest that听while听attaining the knowledge, skills and competencies for effective and safe medical practice听-听the apparent emphases听of examination - they are implicitly also听part听of assessing conduct and trust听of doctors.鈥�听

The study did not distinguish between different levels of sanctions, or sanctions for different reasons. It did not take into account changes to the GMC鈥檚 Fitness to Practise procedures that occurred听over the study period.听The research looked at only two of the UK鈥檚 postgraduate examinations, there being other exams for a range of other medical specialties, but MRCGP and MRCP听(UK) are two of the largest postgraduate examinations in the UK.听

The GMC听will听investigate听a听doctor听if a complaint is made about that doctor鈥檚 fitness to practise by a听member of the public, another professional,听or听an听employer (e.g. hospital)听or other representative of an听institution.听

The Medical Practitioners Tribunal Service (MPTS) adjudicates on complaints made against doctors in the United Kingdom, making independent decisions about a doctor鈥檚 fitness to practise.

Links听

• UCL Medical School听听
• UCL Research Department of Medical Education

Media contact

Henry Killworth

Tel: + 44 (0) 207 6795296

Email: h.killworth@ucl.ac.uk

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