title: Annual Review of Competence Progression (ARCP) performance of doctors who passed Professional and Linguistic Assessments Board (PLAB) tests compared with UK medical graduates: national data linkage study.
abstract: OBJECTIVE
  To determine whether use of the Professional and Linguistic Assessments Board (PLAB) examination system used to grant registration for international medical graduates results in equivalent postgraduate medical performance, as evaluated at Annual Review of Competence Progression (ARCP), between UK based doctors who qualified overseas and those who obtained their primary medical qualification from UK universities.
  
  
  METHODS
  Observational study linking ARCP outcome data from the UK deaneries with PLAB test performance and demographic data held by the UK General Medical Council (GMC).
  
  
  METHODS
  Doctors in postgraduate training for a medical specialty or general practice in the UK and doctors obtaining GMC registration via the PLAB system.
  
  
  METHODS
  53,436 UK based trainee doctors with at least one competency related ARCP outcome reported during the study period, of whom 42,017 were UK medical graduates and 11,419 were international medical graduates who were registered following a pass from the PLAB route.
  
  
  METHODS
  Probability of obtaining a poorer versus a more satisfactory category of outcome at ARCP following successful registration as a doctor in the UK.
  
  
  RESULTS
  International medical graduates were more likely to obtain a less satisfactory outcome at ARCP compared with UK graduates. This finding persisted even after adjustment for the potential influence of sex, age, years of UK based practice, and ethnicity and exclusion of outcomes associated with postgraduate examination failure (odds ratio 1.63, 95% confidence interval 1.30 to 2.06). However, international medical graduates who scored in the highest twelfth at part 1 of the PLAB (at least 32 points above the pass mark) had ARCP outcomes that did not differ significantly from those of UK graduates.
  
  
  CONCLUSIONS
  These findings suggest that the PLAB test used for registration of international medical graduates is not generally equivalent to the requirements for UK graduates. The differences in postgraduate performance, as captured at ARCP, following the two routes to registration might be levelled out by raising the standards of English language competency required as well as the pass marks for the two parts of the PLAB test. An alternative might be to introduce a different testing system.
authors.affiliation: School for Medicine, Pharmacy and Health, Wolfson Research Institute for Health and Wellbeing, Durham University Queen's Campus, Stockton-on-Tees TS17 6BH, UK.
authors.forename: Paul A
authors.initials: PA
authors.lastname: Tiffin
authors.forename: Jan
authors.initials: J
authors.lastname: Illing
authors.forename: Adetayo S
authors.initials: AS
authors.lastname: Kasim
authors.forename: John C
authors.initials: JC
authors.lastname: McLachlan
mesh_terms: D000328:Adult; D002568:Certification / Q000379:methods / Q000592:standards / Q000706:statistics & numerical data; D002983:Clinical Competence / Q000592:standards* / Q000706:statistics & numerical data; D003625:Data Collection; D004521:Educational Measurement; D005260:Female; D005550:Foreign Medical Graduates / Q000592:standards* / Q000706:statistics & numerical data; D006801:Humans; D008297:Male; D006113:United Kingdom
references.citation: BMJ. 2011 Mar 08;342:d901
references.pmid: 21385802
references.citation: BMJ. 2014 Apr 17;348:g2621
references.pmid: 24742473
references.citation: BMC Med Educ. 2013 Jul 30;13:103
references.pmid: 23899223
references.citation: Stat Methods Med Res. 2007 Jun;16(3):219-42
references.pmid: 17621469
references.citation: BMJ. 2009 Jun 29;338:b2393
references.pmid: 19564179
references.citation: BMC Med. 2008 Feb 14;6:5
references.pmid: 18275598
references.citation: Can Fam Physician. 2010 Sep;56(9):912-8
references.pmid: 20841596
references.citation: BMJ. 2013 Sep 26;347:f5662
references.pmid: 24072882
references.citation: BMC Med. 2012 Jun 14;10:60
references.pmid: 22697599
references.citation: Acad Med. 2000 Dec;75(12):1206-11
references.pmid: 11112723
references.citation: Clin Teach. 2012 Oct;9(5):325-9
references.pmid: 22994473
references.citation: Br J Gen Pract. 2013 Nov;63(616):e718-25
references.pmid: 24267854
references.citation: BMJ. 2011 Apr 05;342:d1817
references.pmid: 21467101