What is the medical licensing assessment (MLA)?
The MLA is an assessment that would create a consistent standard of entry on to the UK medical register.
We are defining the aim of the MLA as:
- to create a single, objective demonstration that those applying for registration with a licence to practise medicine in the UK can meet a common threshold for safe practice.
Our current thinking, which is now being tested and developed, is that the MLA would focus on applied knowledge and clinical and professional skills.
How is that different from the current situation - why do we need the MLA?
Currently, there are three main routes to practice in the UK, and no single threshold for entry on to the UK medical register, leading to inconsistency and variation:
- UK graduates: All UK medical schools set their own curricula and methods of assessment - this means that UK graduates aren’t assessed in a common way.
- European Economic Area (EEA) graduates: At present, EEA doctors can work in the UK based on a Directive from the European Commission that requires us to recognise primary and specialist medical qualifications. The GMC is not permitted to check the skills and competence of EEA doctors when they register to practise here. This may change depending on the outcome of the negotiations on the UK leaving the European Union.
- International medical graduates (IMGs): Some IMGs take the two part Professional and Linguistic and Assessment Board (PLAB) test. Others can join the UK register eg through sponsorship arrangements approved by the GMC; or an acceptable postgraduate qualification.
The MLA would help reduce variation and inconsistency by introducing a common threshold for safe practice that those seeking entry to the UK medical register would have to meet.
What benefits will the MLA bring?
Introducing an assessment for entry on to the UK medical register and licence to practise would have a number of benefits, including the following.
- Providing assurance about the practice of doctors joining the medical register, regardless of where they were educated or trained.
- Creating an internationally recognised assessment that is a marker of the excellence of medical education and medical practice in the UK.
- Giving confidence to medical students that they will be assessed by a common threshold – without subjecting them to over-examination.
- Providing a uniform way to test the knowledge, skills and competence of international medical graduates - by subjecting them to the same assessment as doctors emerging from UK institutions. Subject to the outcome of the negotiations on the UK leaving the European Union, our aspiration is that this would include EEA doctors.
Who will need to take the MLA?
All UK students would need to pass the MLA to obtain a Primary Medical Qualification. Medical school final examinations would include a combination of MLA components and assessment components set by each school to reflect their own curricula.
For international medical graduates the MLA will replace the current GMC PLAB test. We may also be able to require EEA doctors to take the MLA, but that will be subject to the outcome of the negotiations on the UK leaving the European Union.
How will the MLA be structured?
We currently envisage an assessment of two parts:
- a test of applied knowledge
- a test of clinical and professional skills.
In our early discussions on the MLA we discussed bringing forward doctors’ first revalidation to review their initial licence to practise earlier than at the current five-year period. We will consider this further as we continue to develop our plans for the assessment, and once the ongoing evaluations and research studies into revalidation are completed.
How are the MLA and the Professional and Linguistic Assessments Board (PLAB) test linked?
Currently most IMGs seeking to practise in the UK take the two-part PLAB test run by the GMC. Others can join the UK register through sponsorship under an arrangement approved by the GMC, through an approved postgraduate qualification or by eligibility to enter the GP or specialist register.
Our current thinking, building on the recent review of PLAB (pdf), is that the MLA would replace the PLAB test when it is introduced in 2022.
How much will the MLA cost?
The GMC intends to invest in a state-of-the-art assessment which secures international recognition. However, until more detail about the format and delivery of the MLA is agreed, estimates of costs are necessarily very approximate.
Our intention is to keep costs to a minimum, and to make use of existing infrastructure and resources where possible.
Would a change in the law be needed to introduce a MLA?
We would not need to seek changes to the Medical Act (1983) to replace the PLAB test with the MLA, or to require medical schools, to include the MLA in their final examinations.
Subject to future negotiations on the UK’s decision to leave the European Union we may be able to require EEA qualified doctors to take the MLA.
What work have you done on the MLA to date?
In September 2014, the Council of the GMC gave its approval (pdf) for work to start to look at the feasibility of introducing a unified assessment for doctors seeking to practise in the UK.
In June 2015, following a thorough programme of preliminary evidence gathering, policy development and engagement, Council agreed that work to develop proposals for the MLA could begin.
As a result we have carried out extensive engagement with key partners across the four nations of the UK. We have visited and discussed options with all the 32 UK medical schools. We are now seeking the views and support of a range of expert advisers and partners to develop the format of the assessment and confirm governance arrangements. We will shortly launch a consultation to invite views on the principles underlying the MLA from all those with an interest in this area, including those in the medical community who we will work with to introduce the assessment; current, recent and prospective students; and patients and the general public.
Who have you worked with to develop your plans for the MLA?
We are keen to collaborate with all those who have an interest in the proposed new assessment.
We have been working closely with all UK medical schools, the Medical Schools Council (MSC) and the Medical Schools Council Assessment Alliance (MSCAA). The aim is to develop the MLA together, building on the innovative work already undertaken to develop common assessments. We will also work with assessment experts to develop proposals for the consultation.
As the project progresses we intend to establish formal governance oversight, bringing together key organisations to shape the development and implementation of the MLA.
Our programme of engagement and evidence gathering includes:
- visiting every medical school in the UK to and seek views on our early thinking
- holding detailed discussions with partners and Government officials from the four nations of the UK
- establishing an expert reference group chaired by Professor Neil Johnson (who also chairs the Medical Schools Council Assessment Alliance) to help develop the format of the assessment
- convening workshops with UK medical school assessment experts, international experts and panellists for the Professional and Linguistic Assessments Board (PLAB) test
- consulting our Education and Training Advisory Board and Assessment Advisory Board
- commissioning and analysing external research; and drawing on evidence from jurisdictions running medical licensing assessments – e.g. in the USA, Canada, Switzerland and Poland
- developing a reference community of individuals who are interested in this project – contact us at email@example.com if you would like to join this community
- holding a public consultation on our plans to introduce the Medical Licensing Assessment, seeking views from all those with an interest in this area including patients and members of the public.
When do you expect to introduce the MLA?
We are still developing our plans for the MLA. We will shortly launch a consultation on the principles underlying the assessment. The feedback we receive will help to shape how we develop the MLA and the timetable for implementing it.
However, we currently envisage that development and piloting would run from 2018 to 2021 and that the MLA would be fully implemented from 2022.
Are UK graduates safe to practise?
We have carried out extensive research and investigations to look at how prepared recent graduates are for medical practice and further training. We concluded that:
- very few UK medical graduates are very poorly prepared for practice
- there is evidence that preparedness has improved and that our requirements in Outcomes for graduates have resulted in curricular changes
- there are, however, some remaining concerns, in areas such as prescribing, emergency care and more generally resilience in a clinical environment
- there is also variation across medical schools in how prepared their graduates feel for clinical practice.
The MLA could help to drive further improvement by creating a single, objective demonstration that those applying for a licence to practise medicine in the UK can meet a common threshold for safe and effective practice.
Aren’t there already enough assessments and examinations?
We have no wish to introduce unnecessary or duplicate assessments.
We are keen to explore how the MLA could be integrated with medical schools final examinations to provide a single, objective demonstration of a common threshold, while enabling universities to include other assessments which reflect the variety of their curricula.
Is the MLA definitely going to happen?
The Council of the GMC has expressed its support in principle and is committed to the development of proposals for the MLA.
We will now carry out a full, formal consultation on the proposals, seeking a wide range of views on the principles underlying the assessment.
Where can I go to ask different questions and let you know what I think?
We would welcome any views on the introduction of the MLA. Please contact our MLA team at firstname.lastname@example.org with any questions or comments. You can also check our webpages for regular updates on the work to develop proposals for the MLA.