Undergoing Tests of Competence as part of a Performance Assessment

1. What are they?

The Tests of Competence (ToC) form part of the Performance Assessment, together with the Peer Review.

The tests are an objective assessment of your knowledge, clinical and consultation skills. The assessment team will observe and score your performance; these scores are then compared with ‘reference groups’ of volunteers who have undertaken the same written questions or OSCE stations. A report is compiled from this, which you will receive once the Performance Assessment is complete.

All Tests start with a briefing, where you will have the opportunity to ask questions. You will then sit a written Knowledge Test and an OSCE (Objective Structured Clinical Examination) and, for certain specialties, a Simulated Surgery or rapid reporting session.

Following these there may be a Post Test Discussion and a short interview to clarify any matters that have arisen during the day. The assessors cannot give you feedback on your performance.  You are allowed to request a break at any stage during the day.

The exact format of the day will vary depending on your specialty and the nature of your work. The assessment will be tailored to your Practice. To do this, we use the information you give us by completing a document called a portfolio. The more relevant information you give us, the better we can tailor the assessment.

You are allowed to be accompanied by a supporter during the briefing and the Final Interview but your supporter will not be allowed to remain in the Skills Centre during the testing.

The GMC is assisted by its agents, the Academic Centre for Medical Education (ACME), in carrying out the performance assessment.  ACME is part of the Division of Medical Education at University College London Medical School (UCLMS).

ACME work with the GMC to develop the assessment methods used during the TOC. Prior to the TOC they assist the team in planning the content of the tests. Following the assessment they will produce the results from the data collected by the assessment team on the day.

You can view a short video, filmed at our clinical assessment centre, about the Tests of Competence: view the video

2. Written Knowledge Test

The topics of the questions will be relevant to your specialty. Most tests will consist of Single Best Answer Questions (SBA), but some may contain Extended Matching Questions (EMQ) or short answer questions.  The type of questions and the time allowed will be in the timetable. 

As a general rule, you will answer the questions by shading a lozenge on an answer sheet which will be marked by a machine.

Example single best answer question

1. A 17 year boy attends the Accident and Emergency Department having been taken ill whilst playing football. He gives a history of sudden onset of left-sided chest pain followed by severe and persistent breathlessness.

   What is the SINGLE investigation most likely to provide a definitive diagnosis?

  1. A. Blood gases
  2. B. Chest x-ray
  3. C. Echocardiogram
  4. D. Electrocardiogram (ECG)
  5. E. Pulmonary function tests

Example extended matching question

Joint pain


  1. a. Ankylosing spondylitis 
  2. b. Erythema nodosum
  3. c. Gout
  4. d. Hyperparathyroidism
  5. e. Joint sepsis
  6. f. Medial cartilage tear
  7. g. Osteoarthritis
  8. h. Psoriatic arthropathy
  9. i. Pyrophosphate arthropathy
  10. j. Reactive arthritis 
  11. k. Rheumatoid arthritis


For each patient described below, choose the SINGLE most likely diagnosis from the above list of options. Each option may be used once, more than once, or not at all.

  1. 1. A 70 year old previously healthy man presents with pain on weight-bearing and restricted movements of the right hip.
  2. 2. A 73 year old woman with rheumatoid arthritis on immuno-suppressive drugs presents with systemic malaise and fever. She has red, hot, swollen wrists.
  3. 3. A 66 year old woman started furosemide (frusemide) two weeks ago and now presents with a red, hot, swollen metatarso-phalangeal joint.
  4. 4. A 22 year old male soldier presents with a two week history of a swollen right knee, conjunctivitis and urethritis.
  5. 5. A 30 year old man presents with a 10 year history of back pain, worse in the morning, and one episode of iritis.

3. OSCE (Objective Structured Clinical Examination)

The OSCE consists of individual stations involving anatomical models, simulated patients or real patients.  The stations last approximately 7 minutes each.

The skills assessed may include history taking, clinical examination, practical communication, written communication, diagnostic and management skills.  Depending on your specialty you may be tested on emergency situations, as well as palliative and terminal care.

You should concentrate on showing the assessor how you perform clinical tasks and interact with patients but any advice you give must be accurate.


As you are being tested in what you actually do, or have done, there should be no need for special preparation.

You should be familiar with the GMC publication Good Medical Practice, and the supporting guidance as you will be expected to respond to situations in line with the advice they give.

You will not be allowed to take any reference material, books or electronic devices into either the knowledge test or OSCE with you.  In certain cases relevant material may be provided e.g. a BNF (British National Formulary)

4. Simulated Surgery/Communication Skills


Depending on your specialty, you may be asked to conduct a simulated surgery or clinic with simulated patients. You will be marked on your clinical, management and communications skills.

Practical tests will be marked independently by the medical assessors using a structured marking schedule. They will record independent scores, which will then be averaged. The lay assessor will judge communication and maintaining trust with the patient and will not produce a numeric score.

5. Rapid reporting sessions

In specialties such as radiology, pathology and microbiology, there will a series of images or slides on which you will be required to make a diagnosis and, in some cases, discuss management of these cases.

6. Arrival

You must make your own arrangements for travel and accommodation. A timetable for your Tests of Competence will be sent to you prior to the date; expect your arrival time to be between 8-8.30am.

7. Where is it?

Your Tests of Competence (ToC) will be held at a Clinical Assessment Centre in the UK. From March 2010 most will be held at the GMC’s Clinical Assessment Centre in Manchester.

8. Reasonable Adjustments

If you have a disability, we may be able to make reasonable adjustments to the Tests. If you would like us to consider making reasonable adjustments please contact your Performance Assessment Officer as soon as possible.