title: Prevalence of GMC performance assessments in the United Kingdom: a retrospective cohort analysis by country of medical qualification.
abstract: BACKGROUND
  The demographics of doctors working in the UK are changing. The United Kingdom (UK) has voted to leave the European Union (EU) and there is heightened political discourse around the world about the impact of migration on healthcare services. Previous work suggests that foreign trained doctors perform worse than UK graduates in postgraduate medical examinations. We analysed the prevalence by country of primary medical qualification of doctors who were required to take an assessment by the General Medical Council (GMC) because of performance concerns.
  
  
  METHODS
  This was a retrospective cohort analysis of data routinely collected by the GMC. We compared doctors who had a GMC performance assessment between 1996 and 2013 with the medical register in the same period. The outcome measures were numbers experiencing performance assessments by country or region of medical qualification.
  
  
  RESULTS
  The rate of performance assessment varied significantly by place of medical qualification and by year; χ2(17) = 188, p < 0.0001, pseudo-R2= 15%. Doctors who trained outside of the UK, including those trained in the European Economic Area (EEA), were more likely to have a performance assessment than UK trained doctors, with the exception of South African trained doctors.
  
  
  CONCLUSIONS
  The rate of performance assessment varies significantly by place of medical qualification. This is the first study to explore the risk of performance assessment by individual places of medical qualification. While concern has largely focused on the competence of non-EEA, International Medical Graduates, we discuss implications for how to ensure European trained doctors are fit to practise before their medical licence in the UK is granted. Further research is needed to investigate whether these country effects hold true when controlling for factors like doctors' sex, age, length of time working in the UK, and English language skills. This will allow evidence-based decisions to be made around the regulatory environment the UK should adopt once it leaves the EU. Patients should be reassured that the vast majority of all doctors working in the UK are competent.
authors.affiliation: University College London Medical School, Royal Free Hospital, room GF/664, Hampstead, London, NW3 2PF, UK.
authors.forename: L
authors.initials: L
authors.lastname: Mehdizadeh
authors.affiliation: UCL Institute of Health Informatics, 222 Euston Road, London, NW1 2DA, UK. h.potts@ucl.ac.uk.
authors.forename: H W W
authors.initials: HW
authors.lastname: Potts
authors.affiliation: University College London Medical School, Royal Free Hospital, room GF/664, Hampstead, London, NW3 2PF, UK.
authors.forename: A
authors.initials: A
authors.lastname: Sturrock
authors.affiliation: Royal College of Physicians, 11 St Andrews Place, Regent's Park, London, NW1 4LE, UK.
authors.forename: J
authors.initials: J
authors.lastname: Dacre
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002983:Clinical Competence / Q000592:standards*; D004521:Educational Measurement / Q000706:statistics & numerical data; D005062:European Union; D005260:Female; D005550:Foreign Medical Graduates; D006801:Humans; D008004:Licensure; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D006113:United Kingdom; D055815:Young Adult
keywords: Brexit; Cohort study; General Medical Council; Performance assessment; Primary medical qualification