12:01AM BST 18 Apr 2014
Half of all foreign doctors in Britain do not have the necessary skills to work here but can practise because the competency exam is too easy, a major study finds.
The majority of the 88,000 foreign doctors in the health service would fail exams if they were held to the same standard as their British colleagues, according to the research.
The disclosure will add to concerns over the reliance of the NHS on foreign doctors. The language ability of some has been questioned in recent years. The research potentially shows more wide-ranging inadequacies. Around 1,300 foreign physicians are licensed each year by the General Medical Council after passing an exam which assesses clinical and language skills.
But the study, by University College London, found that around half would fail to reach the standards expected of British doctors. Its authors have called for the pass rate of the competency exam to be raised from 63 to 76 per cent to “ensure patient safety”.
Chris McManus, professor of psychology and medical education at UCL, said: “There is no real mechanism for checking that doctors coming from outside Britain have been trained to the same level as British doctors. We wanted to find out what level overseas doctors would have to reach if they were to be as competent as British graduates.
I think it’s inevitable that the bar will need to be set higher.
“The fact that you already have overseas doctors being over-represented at GMC hearings is indicative of the problem. Many are simply not trained to the same standards.”
More than 88,000 foreign-trained doctors are registered to work in Britain, including 22,758 from Europe. They make up almost a third of all NHS doctors but account for approximately two thirds of those struck off each year. The Professional and Linguistics Assessments Board, the exam they must pass to practise in Britain, is designed to ensure the same skill level as a British graduate a year after completing medical school.
But UCL discovered there was “no formal mechanism” to ensure the exam was as tough as assessments taken by British doctors. When researchers compared results they found that foreign doctors were consistently performing less well.
Around half of doctors trained abroad would not pass the most comparable British test, the report authors said.
“It may be that some overseas doctors have had poor training and when they come to Britain they will catch up quickly and thrive in a better environment,” said Prof McManus.
“But alternatively some may feel completely overwhelmed, particularly with new technology that they have not yet come across. And that is of concern.”
Figures from 2012 showed that of 669 doctors who were struck off or suspended in the previous five years, 420 had trained abroad.
The country with the largest number of doctors removed or suspended from the medical register is India, followed by Nigeria and Egypt.
In 2011 the GMC set up a working party to review whether the competency exam needed to be updated and asked UCL to compile research. The working party is due to report later this year but UCL’s findings have been made public after they were used to defend an allegation that the GMC was racist in marking the exams of foreign doctors.
The British Association of Physicians of Indian Origin launched a judicial review claiming the GMC failed too many doctors from overseas in GP tests. But a High Court judge ruled against them this month after seeing UCL’s report.
Prof McManus said: “We’ve been through the figures with a fine-toothed comb and there is simply nothing to show that examiners are being racist.”
The Indian physicians’ association (BAPIO) said it was dismayed by the findings. It has called for a common test for all doctors. Dr Ramesh Mehta, its president, said: “We must drive standards up, but we need objective evidence and fair processes. We are foremost NHS doctors and want the NHS to be the best; this blame game is not helpful.”
The GMC said the research raised important questions and agreed that changes were “vital” for patient safety.
“We are determined to do what we can to maintain high standards of medical practice in the UK, regardless of where doctors receive their training,” said Niall Dickson, the chief executive of the GMC.
“That is why we are reviewing the way in which we assess the knowledge and skills of those seeking to practise here … This review, along with our decision to increase the score we require in our assessment of English language skills, will help us ensure that high standards of practice are maintained.”
The study, which is published in the British Medical Journal, also showed that doctors from within the EU fall short.
In 2008, David Gray, a pensioner, died after a doctor trained in Germany, Daniel Ubani, gave him ten times the recommended dose of pain relief while working his first shift as a locum GP.
Tougher language checks for European doctors come into force this summer.
Dr Maureen Baker, chairman of the Royal College of General Practitioners said: “In the interests of patient safety and fairness to international medical graduates, we recommend that the current Professional and Linguistic Assessment Board standard setting process is reviewed as a matter of urgency.”
to international medical graduates, we recommend that the current Professional and Linguistic Assessment Board standard setting process is reviewed as a matter of urgency.”
commend that the current Professional and Linguistic Assessment Board standard setting process is reviewed as a matter of urgency.”
Daily Telegraph 18/04/2014