New UCL research on doctors who trained abroad

In a new paper, researchers from UCL Medical School and UCL Institute of Health Informatics report that doctors who trained abroad are more likely to get their performance assessed by the General Medical Council than UK-trained doctors. The size of the issue varies from country to country, which may have implications for licensing arrangements after Brexit. 

It is unclear whether this effect relates to different medical training around the world, to other factors about doctors from different countries (like their sex, age or what specialty they work in), or to biases against overseas-trained doctors in our society.

The UK, like other Western countries, relies on healthcare staff trained abroad. We need to ensure that staff trained abroad and those trained in the UK reach the same standards. We also need to ensure that all healthcare staff remain competent and keep skills up-to-date.

Current rules mean that doctors who trained in the EU or the wider European Economic Area (EEA) can practise in the UK without further tests of their medical competency, but doctors who trained elsewhere in the world have to pass the Professional and Linguistic Assessments Board (PLAB). We do not know what arrangements will be after Brexit.

The General Medical Council (GMC) are the UK’s medical regulatory body responsible for protecting, promoting and maintaining the health and safety of the public. The GMC can investigate the fitness to practise of doctors when they receive complaints. This may include requiring the doctor to take a performance assessment. We looked at who had been required to take a performance assessment since 1996 and compared that to the profile of all doctors practicing in the UK. This included doctors who were subsequently cleared.

Doctors who trained outside of the UK, including those trained in the EEA, were more likely to have a performance assessment than UK trained doctors, with the exception of South African trained doctors, who showed the same rate as UK-trained doctors. Doctors who trained in Bangladesh were 13 times more likely to have a performance assessment than UK graduates, followed by Nigerian and Egyptian trained doctors who were 8 times more likely.

Poor performance can come in many forms, including poor clinical knowledge, English language skills or a misunderstanding of patient’s culture or the UK’s healthcare settings. Factors such as sex, age and specialty of doctors may explain or partly explain these effects: for example, overseas trained doctors are more likely to be men and men are more often investigated. Our result could reflect true differences in competency, standards of medical training and/or certification between different countries, or it could reflect different treatment of overseas trained doctors by society and employers. Whether differences by country of training reflect differences in the ability of some doctors, or biases in systems of performance evaluation, this is an important phenomenon that further research needs to explain.

There may be implications for immigration arrangements for healthcare professionals, and for what testing we require. With the UK having to negotiate new arrangements after exiting the EU, such questions have become more urgent. In the meantime, patients should be reassured that the vast majority of doctors working in the UK, irrespective of where they trained, are competent, and indeed highly skilled. Further, the NHS could not function without foreign-trained doctors or other healthcare staff.

Mehdizadeh L, Potts HWW, A.Sturrock A, Dacre J. Prevalence of GMC performance assessments in the United Kingdom: a retrospective cohort analysis by country of medical qualification. BMC Medical Education 2017; 17:67. DOI: 10.1186/s12909-017-0903-6