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A systematic review on the impact of licensing examinations for doctors in countries comparable to the UK

What were the key findings?

The systematic review found that:

  • The literature is diverse in its quality, methodology and the evidence it provides for the validity of medical licensure examinations.
  • The literature shows correlations between doctors' performance in licensing examinations and subsequent examination performance, some patient outcomes and rates of complaints.
  • 23 papers were identified that offered empirical evidence for the validity of licensing examinations. Many of these were concerned with the technical aspects of licensure examinations and this is where the strongest validity evidence was found.
  • A number of papers demonstrated how performance in licensing examinations features in later examination selection processes and therefore has career consequences for doctors.
  • Others highlighted performance differences between different groups of doctors. These show that International Medical Graduates (IMGs) perform less well in licensing examinations but don’t establish the reasons why.
  • Some authors claim to provide evidence that licensing examinations ensure greater patient safety and improved quality of care. Currently the evidence for this is based on correlations of performance however rather than a substantive causal link between licensing examinations and improvements in patient care.
  • These correlations are important however and are the first attempts to look at performance and patient outcomes.
  • The remaining 50 papers revealed a general lack of validity evidence and consisted of informed reasoning or opinion and while all drew on research material to argue their case, the evidence used was mostly equivocal.

Why did we commission this research?

The GMC commissioned this research:

  • To establish the existing evidence base for the validity of medical licensing examinations or similar in countries comparable to the UK
  • To establish the validity evidence for the impact of medical licensing examinations
  • To identify best practice and any gaps in knowledge for medical licensing examinations

What did the research involve?

The research involved a systematic review of the available literature, including grey literature. This was supplemented by a website search of relevant bodies in 49 countries comparable to the UK and a survey of international regulators to identify any grey literature.

Full Report

Full Report (pdf)