UK medical schools are playing a key role in helping to develop the Medical Licensing Assessment (MLA). Here, Paul Jones and Andy Grant from Swansea University Medical School and Stephen Riley from Cardiff University Medical School, respond to some key questions from the GMC’s consultation, which closes on 30 April 2017.
As the only two medical schools in Wales, we have responsibility for producing excellent clinicians to work in Wales and beyond. Working with the Wales Deanery we are able to align undergraduate and postgraduate quality assurance processes for effective medical education.
The introduction of a Medical Licensing Assessment (MLA) was suggested in September 2014 by the GMC. Consultation on this proposal has been invited so that all stakeholders can contribute to shaping this assessment as it moves from paper into practice.
Why do we need a Medical Licensing Assessment in the UK?
The opening statement of the MLA consultation document develops the rationale for the MLA as a common threshold such that the competence of new doctors, and therefore patient safety, can be assured.
The public has always rightly assumed that each medical school has specific knowledge and skills which they require each of their qualifying medical students to achieve to become practising doctors. These are based on the learning outcomes in Outcomes for graduates. The GMC, as the regulator, has an overarching role to ensure these outcomes are met through their visits and interactions with each of the medical schools in the UK.
However, the standard by which each medical school sets the threshold for ensuring a safe and competent graduating doctor is left to individual schools to define. External examiners are used to calibrate the passing standard between medical schools.
However, recent work published in Medical Education by Celia Taylor and colleagues demonstrates that there is a significant difference between schools in the passing standard of common core levels for written exams.
This does not suggest that the school with the lowest standard is graduating unsafe doctors. We are not aware of any data showing that individual schools are overrepresented when junior doctor referrals to fitness to practice are considered.
So, rather than concerns over safety, one could make a case for the MLA on the grounds of fairness with students having an equal chance of passing the final examinations no matter which school they attend.
How might the MLA fit into finals?
The implications of including such an assessment into the final year examinations in all medical schools are far reaching. The timings of all final year exams at UK medical schools vary greatly, as do the formats for each constituent part of the exams.
Introducing a common ‘core’ of questions, whether they be in the format of knowledge based questions or Objective Structured Clinical Examination (OSCE – practical test of clinical skills) type scenarios would force medical schools to all use the same format of examination. How would this format be decided upon? Who would decide? The question would need to be asked if an 8-minute OSCE station is better than a 10-minute OSCE station – and so on.
Medical schools have striven over many years to make their examinations as valid and reliable as possible. Experts currently located in all medical schools around the UK are best placed to say what approach is best.
When should UK medical students have to sit the MLA?
The timing of the examination also needs careful consideration. Even though it is stated that the MLA would not become a ranking examination, with the ability of individuals (and indeed organisations) to obtain results through FOI (Freedom of Information) requests, we are concerned for the anonymity of each of the schools in a ranking order. This will then encourage schools to make the sitting of the examination to be as late as possible in their particular curriculum so as to gain the advantage of more experienced students sitting it to achieve higher marks.
Welsh medical schools have focused the final year of study on preparation for practice. Time and attention are channelled on the clinical knowledge and skills that a newly qualified doctor needs to be able to do safely right at the outset. A combined student assistantship in Wales means that all students that are to remain in the Foundation Programme in Wales get to be part of the team with which they are going to work once they graduate. We would not want an MLA to distract our students from learning this vital training in direct patient care.
These are just a couple of points to consider in the implementation of an MLA in the UK. Please take the time to participate and give your views on this important development in UK medical education and licensing.
At Swansea University Medical School, Mr Paul Jones is Programme Director and Dr Andy Grant is Dean of Medical Education. Dr Stephen Riley is Dean of Medical Education at Cardiff University Medical School.
The GMC’s consultation on the Medical Licensing Assessment (MLA) closes on 30 April 2017 – share your views now.