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GMC more likely to sanction doctors with poor exam performance

Worst performing doctors 12 times more likely to be sanctioned

Adrian O'Dowd

Friday, 07 December 2018

Doctors who perform poorly in postgraduate professional exams are up to 12 times more likely to face sanctions by the General Medical Council (GMC) than the best performing doctors, suggests a large data linkage study* published today in BMC Medicine.

The study by University College London (UCL) and University of Cambridge assessed the exam results of UK doctors who had taken knowledge-based exams and clinical assessments set by the Membership of the RCGP (MRCGP) or the Membership of the Royal Colleges of Physicians of the United Kingdom (MRCP(UK)).

The researchers linked the exam data to GMC data on Fitness to Practise sanctions against medical doctors, the most serious of which is being struck off or erased from the medical register, alongside other sanctions such as suspension from the register or receiving a warning for very poor behaviour or performance.

Tens of thousands of examination results were obtained for UK registered doctors taking the MRCGP Applied Knowledge Test or Clinical Skills Assessment at first attempt between 2010 and 2016, or taking the MRCP(UK) Part 1, Part 2 or Practical Assessment of Clinical Examination Skills at first attempt between 2001 and 2016.

Exam data were linked with GMC actions on a doctor’s registration from September 2008 to January 2017.

Analysis of the results showed that doctors sanctioned by the Medical Practitioners Tribunal Service (MPTS) – which makes decisions independent of the GMC – had previously scored substantially lower on both the knowledge and clinical skills assessments in MRCGP and MRCP (UK), with clinical assessments predicting sanctions somewhat more strongly.

The researchers found, that each additional increment in knowledge or skill contributed to a reduced likelihood of later sanctions.

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%.

Co-author Dr Katherine Woolf (UCL Medical School) said: “The findings demonstrate that postgraduate examinations measure important high-level knowledge, skills, and attitudes, which underpin doctors’ real world behaviour. The findings contradict the frequent assertion that postgraduate medical examinations are unrelated to doctors’ clinical practice.”

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

“Doctors who are not fit to practise endanger patients and others, and the GMC is understandably strict about such matters.

“However 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.

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


*Wakeford, R; Ludka, K; Woolf, K and McManus, I C. Fitness to practise sanctions in UK doctors are predicted by poor performance at MRCGP and MRCP(UK) assessments: data linkage study. BMC Medicine201816:230. DOI:10.1186/s12916-018-1214-4

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