Creating a more straightforward route to medical practice

Today, we have launched a consultation on plans to develop a Medical Licensing Assessment (MLA). Here, our Chair Professor Terence Stephenson, explains why we believe the MLA is needed.

One of the reasons I chose medicine as a profession is its capacity to constantly challenge and surprise.

I’ve seen huge changes since I qualified as a doctor, but perhaps the most surprising thing is what has not changed at all: there is still no unified method of entry to the UK medical register, or a single assessment to test the skills, competence and quality of doctors seeking to practise here.

Agreeing a threshold of competence

There are 32 medical schools in the UK, and each sets its own curriculum and methods of assessment. That’s 32 slightly different ways of determining if a doctor in training is up to entering the profession.

It can’t be right that medicine marks its own homework. So how do we make sure that doctors reach an agreed threshold of competence and preparedness?

We’ve done some research [PDF] and found that not all doctors leave medical school feeling prepared for practice to the same level. Doctors in training can’t possibly be fully prepared as they go into foundation training but it’s up to us to ensure they’re as ready as possible.

Terence Stephenson speaks at GMC conference 2016

Terence Stephenson speaks at GMC conference 2016

Creating a more straightforward route to practice

Our proposal is to introduce a Medical Licensing Assessment (MLA) for all medical students, building on the work already done by the Medical Schools Council to introduce a common bank of questions for final exams.

Our aspiration is that this assessment should apply to doctors who join the medical register wherever they obtain their degree.

This would create a straightforward and transparent route to medical practice in the UK. We believe it would be fairer and more reassuring for the public for there to be a standard for entry to the register that everyone can rely on. Over time we are confident that the MLA could become an international benchmark test for entry to medicine.

We don’t want to create a one-size-fits-all system of undergraduate education – the diversity of our current medical schools can and should be cherished – but we do think all those becoming doctors in the UK should demonstrate that they have the skills and competence to practise here by passing the same assessment.

Many experts in medical schools recognise the value such an examination could bring. A Medical Licensing Assessment would promote consistency and fairness. And, the 35% of NHS doctors who qualified overseas could take the test free from claims of discrimination, as the assessment would be matched to the standards of UK doctors.

Our Education team speak to doctors and educators about the MLA proposals at GMC conference 2016

Our Education team speaks to doctors and educators about the MLA proposals at GMC conference 2016

Gathering expertise and working with partners

I am the first to admit that we do not have all the answers and it would be foolhardy to embark on such a mission without the views and support of experts. We spent the early part of 2016 visiting all medical schools to hear from as many educators as possible. A genuinely valuable MLA will take time to deliver and of course we shall have to work closely with our partners to deliver it.

In an increasingly mobile world, the setting of a clear and respected threshold for entry to UK medicine would have huge advantages for medical education and practice in this country, and for its international reputation, bringing us into line with best practice in other countries.

The GMC’s consultation is open from 31 January to 30 April 2017. To read the proposals and give your views, visit

11 responses to “Creating a more straightforward route to medical practice

  1. I fully support this Terrence. However we got to assess softer skills of being good doctors. It is a sad reality that we teach doctors to be clinically competent but sadly do not teach patient safety, dealing with difficult colleagues, dealing with complaints, leadership and management and not even what NHS means and how much every costs and value for money!

    We don’t even teach professional regulation, why doctors harm patients, dealing with stress and seeking help, substance misuse amongst doctors and so on.

    GMC as a regulator can and should do more to make sure we make good doctors with excellent leadership and management skills and are patient safety champions.

    We got to restore pride back in our noble and most respected and trusted profession.

    You and I are in the final stages of pur professional career and had amazing career. You are very famous and I am still unknown quantity. But both of our aim is same and that is to make NHS safest the best and most vibrant health care and future doctors are better leaders than us. This is the legacy which we got to leave and what a legacy that would be!

    Under your leadership GMC has come a long way and now we simply got to build on it.

    This is one more step in the right direction.

  2. Welcome and long overdue step. The question of giving PLAB exemption to up to 700 doctors every year is unacceptable in this day and age. I do not include the EU qualified EU citizens in this number. Unless we have a uniform standard of entry mechanism, GMC will be accused of being inconsistent in the way different doctors enter the register.

  3. This is a well meaning but extremely unfortunate mistake. The GMC is not the right body to oversee such a move even if it were desirable. It is the GMC’s business to ensure that all qualified doctors working in the UK (whether they qualified overseas or in Britain) are safe. It is the job of medical schools to equip students with the necessary scientific understanding and intellectual resources to cope with the dramatic changes in medicine that will take place over the next forty years. The two roles are very different. The GMC should concentrate on doing its job, medical schools should concentrate on doing theirs.

  4. Assessment drives achievement. But if it is to be of educational benefit it has to be part of a continuum starting with admission, and focused on a curriculum. Don’t impose an assessment at the end of a long complex process of which you are hands off. You will be worse off, it won’t asess what was taught nor the learning of those who undertook the course. Instead you should design a national core curriculum – which would allow all medical schools enough freedom to diversify. But the key concern of a core curriculum would be to ensure we all know what the common standards are expected to be.

  5. What is the foundation programme for? We already have a unified method for assessing doctor’s and I don’t see why we need to push more. The GMC already regulates UK med school exams to ensure new doctors are adequately trained. It seems to me regulation body’s should regulate and a training body should train. I can’t see how letting the GMC create more money making exams will help any one other than the GMC.

  6. I think this is a very bad idea and is a long way beyond the GMC’s remit. The current crisis in recruitment and retention has nothing to do with Undergraduate Education. The GMC is part of the problem not the solution.

  7. This is a bad idea. Please concentrate on your role of ensuring good practice for qualified doctors within the uk and do this to the best of your abilities rather than extending beyond your scope of practice.

  8. While being confident of a safe and highly qualified workforce is important, I think this is a terrible idea.

    I think the idea that you can create this test and instantly provide a much stronger guarantee than currently exists is laughable.

    One of the greatest merits of this country is the strength of the institutions, ranging from the judiciary, the police and indeed our educational establishments.

    Our medical schools are some of the finest in the world and have had centuries to develop excellent methods of both teaching and examining it’s students.

    While it may well be true each medical school examines its students slightly differently there is no suggestion they are not doing so robustly and are already very tightly regulated by the current regulatory framework.

    Each medical school has different research and teaching subspecialty interests and allowing medical schools to pursue areas of interest both in teaching and examination I believe encourages enthusiasm both institutionally and for the student. The GMC already sets stringent criteria on what medical schools are obligated to teach and assess and I don’t think subtle inter-school variation is in and of itself a bad thing.

    Creating this examination is bad on a number of levels.

    Firstly it creates a significant extra layer of bureaucracy and cost.

    Secondly and more importantly it erodes the relationship between the medical school and the student. By outsourcing finals examination it encourages a teaching to the test approach, rather than a broad, holistic and engaging curriculum. It strongly communicates that we as a nation do not have faith in our own medical institutions and would rather favour a centralised approach which doesn’t encourage innovation and interest.

    This article acknowledges the risk of creating a one size fits all approach and damaging the diversity which currently exists, but dismisses the risk as unlikely. I feel this risk would be highly likely and damaging were it to occur.

    Of course we want a knowledgeable, skillful, caring and experienced workforce, straight out of medical school, I don’t see how making everyone sit the same set of mcq’s and OSCE stations will ensure this. The goal should be to encourage innovative passionate teaching and stimulate hard work and conscientious learning on the part of the student. The way to achieve this is good staffing levels, exciting curricula and availability of resources at medical school such that both academic and clinical skills and judgement can be learnt effectively.

    We have a fabulous set of medical schools, the world’s envy, let’s not intervene to create something incredibly costly and damaging to our current process of medical education.

  9. This seems like a poor solution to a very simple issue. Medical students undergo enough examinations currently and an added examination can’t guarantee a future doctor will understand how to handle and cope in real life circumstances to the above mentioned issues. Surely the GMC should be trying to do better at their current job of regulating current UK Medical School curriculum than trying to impose yet another examination on students.

    It also has to be mentioned that as much as you try to simulate or examine either clinical or interpersonal skills via OSCEs or written examinations in the years of medical education, the abilities required to tackle these matters are best learnt through real life experience. Every young doctor will initially feel out of their depth but our development and confidence relies on repeated exposure to real patients and scenarios with the support of a good medical team.

  10. Medical students are already in rigorous and confined environment of training and education as designed by GMC,IMC ,AMC & WHO etc through out the world ; additional examination will be heavy back pack in the curriculum which I think may cause decrease in entrance of medical school by the decent students and also will increase in more drop out . A good number of students do not like long years of training in medicine as compared to other career.
    Definitely some examination which can offer international practice capabilities would be more worthy and meaningful.

  11. Pingback: Top tips from a PLAB examiner: how to succeed in Part 2 | General Medical Council·

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