The MLA and UK students

We are still discussing and developing the Medical Licensing Assessment (MLA) that will be taken both by UK students and international medical graduates (IMGs). This involves medical schools and students. We also work with a group of experts from across medical education and training. So some of the answers on this page only show our latest thinking. As we discuss the practical details, we'll refine our plans. We'll update this page to show the latest position.

Who will take the Medical Licensing Assessment?

When will the MLA start for UK students?

To register with a licence to practise, students graduating in 2024 onwards will need to have passed a degree that includes the MLA. For some students, this means that MLA testing will take place in 2023.

My course dates mean that I will have to do the MLA only if I intercalate, so should I avoid intercalating?

No. We don't think any student should worry about doing this. If you can pass your medical degree, you should be more than ready to pass the MLA. Intercalation offers the possibility of broadening your education and gaining an extra qualification. It also contributes points towards the score used to rank Foundation Programme entrants. Giving up the option to intercalate just to avoid the MLA would be disproportionate and a lost opportunity.

Passing the MLA

How can I prepare?

You will not need to learn anything beyond what's already covered in your degree. Your degree is all the preparation you need.

We will provide an opportunity to get familiar with the way the on-screen testing works. We will also provide sample papers so that you can understand the format of the test.

Your school may also decide to be part of our pilot to see in advance how it will work. The pilot will be a test run to check whether it will work as intended. Taking part in the pilot won't count as attempting the MLA but it may be useful preparation! It will help us make sure everything is working properly for all students.

What about mitigating circumstances and reasonable adjustments?

We are discussing this with medical schools, as well as wider stakeholders and our expert reference group. We have not decided yet. Our current thinking is that we would set guidance and medical schools would make the final decision.

How will you make sure medical schools will do enough to prepare students?

The MLA will be based on our Outcomes for graduates. Every school already has to ensure its graduates know and can do all the things listed in the Outcomes.

So every school should be preparing students already! We already check that schools are preparing students to meet the Outcomes. There is an annual return from schools. We also carry out quality assurance visits.

We are currently looking at our quality assurance process to make sure that we do quality assurance as well as possible.

When I pass, do I still get provisional registration, or will I get full registration?

UK students who graduate will apply for provisional registration as happens now. While there has been a discussion in medical education and training about whether to abolish provisional registration, the MLA is separate from that discussion.

How does my result affect the ranking for entry to the Foundation Programme?

The MLA is being designed as a pass/fail assessment, and not as a way to rank students. It will not directly affect the score that each student is given for Foundation Programme entry. That uses results from the situational judgement test and the educational performance measure (EPM).

The EPM is a score out of 50 made up of three elements.

  • Up to 5 points are available for intercalated degrees and other qualifications.
  • Up to 2 points are available for having academic publications.
  • Between 34 and 43 points based on the ranking which your medical school gives you. Your school will rank your year group into ten groups (deciles) using criteria they choose. Those in the top group get 43 points. Each decile is worth 1 more point than the decile below, so the lowest score given is 34 points.

Most schools will submit EPM scores before their students take the MLA and will not be able to use the result. Some schools may be able to use the result as a part of their decision when ranking students into deciles and may choose to do so. Others may choose to disregard it.

Even if your school considers the MLA when ranking, it's important to note that your decile is decided only in relation to other students in your school. A student whose ranking has included consideration of their MLA result cannot be advantaged or disadvantaged compared to a student whose ranking is not influenced by it.

If things go wrong

If I don't pass, can I have another attempt?

Our current thinking is that we will set a maximum number of attempts. We are still deciding the exact number.

Medical schools would then decide how many attempts to allow their students (up to the maximum). For the knowledge test, you will enter the next available sitting. There will be no specific resit dates or papers. For the CPSA, resits will be in line with medical school policies.

What about appeals?

A robust and fair appeals system will be an important part of this. You could still sit other assessments while appealing your result. We are discussing appeals with schools, students, stakeholders and our group of experts. Whether you would appeal to your school or to us could depend on the content of the appeal.

What happens if I pass the rest of my degree but fail the MLA?

The MLA will be part of the requirements for your degree. If you fail it, just as if you fail any other degree requirement, you will not graduate. In the same way, if you pass but don't meet the other requirements for your degree, you will not be able to graduate.

What happens to a student if you decide that their medical school doesn't meet the CPSA requirements?

We will work with and support schools to ensure that their CPSA can meet the requirements from when the MLA starts. We anticipate that all schools will be compliant with the requirements by the go live date.

How will you be sure this is doing what it is supposed to do?

We will pilot the assessment in 2021 and 2022 to make sure it works as expected. From 2023, we'll carry out a check after each AKT paper to make sure there are no issues with it. We will also assess the impact of the whole MLA. This will include checking that it is achieving its aims. It will also include checking that it is not unfairly disadvantaging any group.

Managing costs and assessment burden

Will students have to pay to take this?

No. We won't impose any extra cost on UK students to take the AKT. The CPSA for UK students will be part of their course, as now. Costs will be met by universities, including from course fees. Some medical schools do charge for resits, and these fees may apply to anyone resitting the MLA as part of their degree requirements.

Will this create a bigger exam burden?

You will not need to learn anything beyond what's already covered in your degree programme. Your degree is all the preparation you need.

The clinical and professional skills assessment (CPSA) will be delivered through the medical schools' arrangements in place in 2023. So this will not be an extra burden to students.

We are working with medical schools to see how the applied knowledge test (AKT) can fit into their programmes of assessment. We know some schools are already considering whether it could replace an existing test.

Will it include the current situational judgement test and prescribing safety assessment?

No. We do not control these tests and they will both remain separate.

Effects on medical schools

How will you make sure that you protect the variety in medical schools' curricula?

The MLA is not about producing a single type of doctor. It does not set a new curriculum. The content map will be based on the Outcomes for graduates, which schools already use. It is an assessment that demonstrates you meet the common threshold for safe practice, not that you fit an exact template.

This will be one part of a degree. It will not stop schools focusing on excellence in certain areas. Schools will still assess across the curriculum. They can still emphasise those areas that define their course.

For the AKT, there will be a standard assessment approach, but it is one commonly used by medical schools already to test applied knowledge. We also won't mandate that schools use particular assessment methods for anything else. We recognise that a range of assessments is good practice. So schools will be able to use assessment methods they think work best for assessing clinical and professional skills within their course. We have built this into our model in using a quality assurance approach to the CPSA.

Could results be used to rank UK medical schools?

The MLA will generate data. In line with our commitment to transparency, we're likely to release whole school data, for example - overall pass rates. Someone could use this data to create a ranking or league table.

We will discourage others from using simplistic measures to rank schools, although we cannot stop them doing it. We are discussing with medical schools how we could produce fairer, more nuanced data.

We would not release students' individual scores.

Getting involved in developing the assessment

We are meeting each medical school to discuss how we'll introduce the MLA. As part of that, we are meeting students to explain more and get feedback from them.

We have met members of the BMA medical students committee executive on several occasions to discuss our plans. These meetings will continue. We also met the medical students committee in Wales and hope to meet with the equivalent committees in Scotland and Northern Ireland. The BMA MSC also sit on our Education Advisory Forum. This forum advises on education issues, including the MLA.

In late 2018 arranged a conference with the Medical Schools Council. We invited all medical schools to send student representatives to hear about the model and offer comments.

All these discussions help us to understand your queries and concerns. We feed these into our discussions with our expert advisers, our other stakeholders, and our Council, about the design and delivery of the MLA.

If you wish to make any comment, you can also email us.