PLAB and UK graduates’ performance on MRCP(UK) and MRCGP examinations: data linkage study
BMJ 2014; 348 doi: https://doi.org/10.1136/bmj.g2621 (Published 17 April 2014) Cite this as: BMJ 2014;348:g2621
- 1UCL Medical School, University College London, London WC1E 6BT, UK
- 2Research Department of Clinical, Educational and Health Psychology, University College London
- 3Hughes Hall, University of Cambridge, Cambridge CB1 2EW, UK
- Correspondence to: I C McManus i.mcmanus{at}ucl.ac.uk
- Accepted 4 April 2014
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.
Design Data linkage of GMC PLAB performance data with data from the Royal Colleges of Physicians and the Royal College of General Practitioners on performance of PLAB graduates and UK graduates at the MRCP(UK) and MRCGP examinations.
Setting Doctors in training for internal medicine or general practice in the United Kingdom.
Participants 7829, 5135, and 4387 PLAB graduates on their first attempt at MRCP(UK) Part 1, Part 2, and PACES assessments from 2001 to 2012 compared with 18 532, 14 094, and 14 376 UK graduates taking the same assessments; 3160 PLAB1 graduates making their first attempt at the MRCGP AKT during 2007-12 compared with 14 235 UK graduates; and 1411 PLAB2 graduates making their first attempt at the MRCGP CSA during 2010-12 compared with 6935 UK graduates.
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.
Results 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.
Footnotes
We thank Michael Harriman, Katharine Lang and William Curnow for their help in understanding the processes of the PLAB examinations; Daniel Smith and Andy Knapton for help with data merging, and Daniel Smith for additional data analyses; Thomas Jones for facilitating various aspects of the study; Jane Dacre and the Royal Colleges of Physicians for giving permission for the analysis of MRCP(UK) data to take place, and Liliana Chis for helping in the preparing of those data; and Sue Rendel and the Royal College of General Practitioners for their permission to analyse the MRCGP data. We particularly thank Daniel Smith for his careful reading of the manuscripts.
Contributors: ICM is the guarantor for the study. The original idea for the study came through discussions between ICM and RW. ICM was responsible for the linkage of the MRCP(UK) and PLAB data, and RW was responsible for the linkage of the MRCGP and PLAB data. ICM and RW worked together on their analyses. The current paper is based on the report which ICM and RW submitted to the PLAB Working Party. The manuscript has been produced collaboratively by the authors. Collectively ICM, RW, and the General Medical Council are responsible for the data, although not all have seen all data.
The report on which this paper was based has been seen by members of General Medical Council staff and members of the PLAB Working Party, and useful comments received from them.
Funding: No funding was made available to ICM and RW for the present study, but ICM has received attendance allowances for meetings of the PLAB Working Party.
Competing interests: Both authors have completed the Unified Competing Interest form at ICMJE uniform disclosure form at www.icmje.org/coi_disclosure.pdf and declare: ICM is a member of the General Medical Council’s Working Party on the PLAB assessment and has received attendance fees from the GMC, and is educational advisor to the MRCP(UK); RW has been an educational advisor to the MRCGP since 1984.
Ethical approval: Not required..
Data sharing: No additional data are available.
Transparency: The lead author, the manuscript’s guarantor, affirms that the manuscript is an honest, accurate, and transparent account of the study being reported; that no important aspects of the study have been omitted; and that there are no discrepancies from the study as planned.
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