What is the medical licensing assessment (MLA)?
The MLA is an assessment that would create a common threshold for 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 is that the MLA would focus on applied knowledge and clinical and professional skills. More details about our proposals are in our consultation document (pdf).
What are you consulting on?
There are 19 questions in the consultation document. The topics covered include the aim and the case for change; the scope and assessment blueprint; the framework of two tests, one of applied knowledge, the other of clinical and professional skills; the level and status of the MLA; who will take the MLA; resource implications; governance and review; implementation; and impact.
For more information, go to our MLA consultation page.
How can I take part?
You can take part in the consultation by completing the online questionnaire on our consultation website or by filling in your comments on the consultation document (pdf) and sending it to us at email@example.com.
Why do we need the MLA?
The fundamental case for introducing a medical licensing assessment is to demonstrate that doctors entering UK practice meet a common threshold, no matter where they obtained their medical degree.
Currently, there are three main routes to practice in the UK and differences in the standards required for entry on to the medical register.
- Students passing finals at UK medical schools – While we regulate medical schools and lay down the outcomes that graduates must meet, there is no UK-wide curriculum or assessment process and final exams (finals) vary substantially between the established medical schools.
- International medical graduates – Many international medical graduates, holding primary medical qualifications obtained outside Europe, gain registration by taking our Professional and Linguistic Assessments Board (PLAB) test. Others use other ways to register which do not involve passing the PLAB test, primarily by holding a postgraduate qualification that we accept or through sponsorship by an organisation that we recognise for this purpose.
- European Economic Area graduates – EEA graduates are currently entitled to have their qualifications recognised here without any test of their competence due to European law.
The MLA would create a single objective demonstration that doctors entering UK practice have met a common threshold for safe practice. It would give everyone, particularly patients and the public, confidence that doctors, wherever they’ve qualified, have met the same threshold of competence.
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.
- Supporting soundly based confidence in and respect for new doctors among their patients, colleagues and employers, no matter where the doctors were educated or trained, thereby enhancing the high reputation of the medical profession in the UK.
- Creating a marker of the excellence of UK medical education and practice.
- Being demonstrably fair to candidates whichever medical school they attended and whether they come from the UK, Europe or the rest of the world.
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 Professional Linguistic Assessment Board (PLAB) test. In addition, we hope that in future we will be allowed by law to test the knowledge and skills of EEA graduates through 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.
Sir Keith Pearson, Chair of our Revalidation Advisory Board, has recently completed an independent review of revalidation. His recommendations include that we should ‘consider’ setting an early revalidation date for newly-licensed doctors so that they receive their first revalidation date within two years of commencing practice in the UK. We will be working with all our key interests, including those most closely involved in postgraduate training, to see whether there may be some merit in doing this for some cohorts of doctors. In that context we have decided to focus this consultation on the two conventional assessments that we believe should form the core of the MLA.
How are the MLA and the Professional and Linguistic Assessments Board (PLAB) test linked?
Our current thinking, building on the recent review of the PLAB test is that the MLA would replace the PLAB test when it is introduced in 2022.
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.
At a later stage, we will consult on which types of overseas doctor could be exempted from the requirement to pass the MLA
How much will the MLA cost?
The cost of the MLA will be subject to decisions on its format and delivery, which will be made in light of the feedback we receive through our consultation. We expect that the GMC will bear the development costs of creating a world class assessment, but we also need to consider how the ongoing costs would be met.
Under our proposals, the MLA for overseas candidates would be funded through their fees while the cost for UK candidates would be met by the GMC and by the medical schools, since they run the finals that would include the MLA tests.
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.
If possible once the UK’s new relations with the EU have been agreed, we would look to the UK Government to make amendments to our powers as set out in UK law via the Medical Act 1983 and so enable us, among other things, to require EEA graduates to take the MLA in line with other doctors entering UK practice.
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.
We’ve since worked closely with assessment and legal experts and with medical schools, other educational bodies and the four governments of the UK. In particular, we visited all UK medical schools in early 2016. Discussions with their staff were very influential in developing the current plans and particularly the proposal to link MLA components with university finals.
In the current consultation we are inviting 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 co-produce the assessment.
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 included:
- 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, Poland and Japan
- developing a reference community of individuals who are interested in this project – contact us at firstname.lastname@example.org if you would like to join this community
When do you expect to introduce the MLA?
The consultation on plans to establish the MLA is open from 31 January to 30 April. The feedback we receive will help to shape how we develop the MLA and the timetable for implementing it.
However, we currently envisage that the MLA would be fully implemented from 2022, after a period of extensive development and piloting.
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 have concluded that very few UK medical graduates are very poorly prepared for practice, however there is variation across medical schools in how prepared for practice graduates feel.
Aren’t there already enough assessments and examinations?
We have no wish to introduce unnecessary or duplicate assessments.
Integrating the MLA into finals is intended to avoid increasing the assessment burden on medical students. Medical schools will not wish to duplicate the MLA elements of finals with additional home-grown assessments that cover the same ground in a similar manner. In light of the responses to our consultation, we will be working closely with experts from medical schools, royal colleges and faculties and other organisations to identify the best possible form of integration into finals.
What will happen after the consultation?
The Council of the GMC has expressed its support in principle and is committed to the development of proposals for the MLA.
Our full public consultation on the proposals is seeking a wide range of views on the principles underlying the assessment.
We will consider all the responses to the consultation and prepare a report on our findings. This report will be considered by our Council – our governing body – along with recommendations on the way ahead.
Subject to the outcome of this consultation and Council’s view, we envisage developing detailed plans with experts and partners. We would then pilot the assessment extensively with a view to implementing the MLA fully in 2022.
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 – find out more about how to take part in our consultation on our dedicated webpages. If you have any additional questions or comments you can contact our MLA team at email@example.com.