Making the healthcare profession fairer to ensure high standards

Research by UCL’s Research Department of Medical Education has highlighted inequalities in assessment standards across institutions, leading to several important changes in policy and practice.

In the UK, most new medical practitioners have undertaken a recognised five-year medical degree before joining the General Medical Council (GMC) Medical Register as junior doctors, and to become a Consultant or GP requires five to ten more years of postgraduate training and extensive examinations.

Examinations are often criticised as irrelevant to medical practise; however, Professors Chris McManus, Katherine Woolf, Jane Dacre and colleagues have shown inconsistencies in examination standards and linked these to the quality of professional practice.

Finding inconsistencies in assessments

A study of 72,000 doctors' exam results showed that greater knowledge and skills as measured by those exams predicted fewer GMC Fitness to Practise sanctions.

In a separate study of 28,000 doctors, the team found significant variation in the knowledge and skills of graduates of different UK medical schools, despite all the graduates having passed their final examinations. This suggested variation in standards across medical schools.

The team also examined assessments of doctors who have qualified outside of the EU. Most of these professionals must pass the GMC’s Professional and Linguistic Assessment Board (PLAB) examination to practise in the UK. Research led by McManus for the GMC’s PLAB review showed that doctors gaining a licence via PLAB had poorer knowledge and skills than UK medical graduates.

The team's research has driven the GMC’s introduction of a new UK Medical Licensing Examination (UKMLA) that was agreed in principle in 2014 and will be fully implemented by 2024. The UKMLA will ensure all doctors in the UK reach a common threshold for safe practice in clinical knowledge and skills, with 14,000 overseas doctors and 9,000 UK medical graduates taking the UKMLA annually.

Creating a fairer workplace

Further research from the team showed that on average doctors and medical students from ethnic minority groups performed less well than their white counterparts in assessments.

Through GMC commissioned research, the team explored the underlying causes and identified 12 risks faced by ethnic minority doctors during training including difficult relationships with seniors, increased likelihood of isolation, and greater mental health issues hindering learning and performance.

The team made recommendations for non-stigmatising interventions including a focus on improving trainee-trainer relationships at work and organisational changes to improve trainees’ social support.

The work informed the GMC Equality, Diversity and Inclusion Strategy 2018-2020. All medical schools, Royal Colleges and Health Education England must now provide fair education and training for their 100,000 medics, and equalities training for providers and those providing quality-assurance training.

The power of collaboration

Research undertaken by Professor McManus and colleagues demonstrated the statistical power of large-scale collaborative studies of medical education in contrast to studies of single medical schools.

This research provided proof of concept for the development of UKMED, with Professor McManus playing a pivotal, sustained role in its development. UKMED tracks undergraduate and postgraduate performance of new doctors across their education and future career, providing high-quality evidence for research and policy addressing issues including attainment and participation.

Links

• Professor Chris McManus’s academic profile
• Professor Katherine Woolf’s academic profile
• Professor Dame Jane Dacre’s academic profile
• UK Medical Education Database
• UCL Faculty of Medical Sciences 
• UCL Faculty of Medical Sciences REF 2021

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• Image credit: iStock/fizkes