GMC sanction 12 times more likely for doctors who do badly in postgrad exams

Doctors who perform poorly in postgraduate professional exams are twelve times more likely to face fitness-to-practise sanctions later in their career, research shows.

GP consultation (Photo:
GP consultation (Photo:

A study by University College London (UCL) researchers published in the journal BMC Medicine found a strong correlation between UK doctors who had performed badly in their first attempts at the MRCGP or MRCP exams and those who had been sanctioned by a medical tribunal after being referred to the GMC.

Doctors in the lowest 2.5% of exam performance were roughly 12 times more likely to receive sanctions than those in the top 2.5%, the study found.

It also found that the longer a doctor had been on the medical register, the more likely they were to be sanctioned - from 0.5% of doctors in the first 10 years after graduation to 2% within 30 years and 3.1% after 50 years.

Exam results

The study looked at exam results for tens of thousands of UK registered doctors and cross-checked the data with fitness-to-practise sanctions imposed by the Medical Practitioners Tribunal Service (MPTS) including erasure, suspension, conditions on practice, undertakings or warnings.

Exam results were obtained for all doctors taking the MRCGP applied knowledge test or clinical skills assessment between 2010 and 2016 and all doctors taking the MRCP(UK) part one, part two or practical assessment of clinical examination skills between 2001 and 2016. Results were then linked with MPTS actions on a doctor’s registration from September 2008 to January 2017.

‘This study is the first to demonstrate for UK postgraduate examinations that knowledge assessments and clinical assessments are independent predictors of fitness-to-practise sanctions,’ the authors said.

‘Postgraduate examinations may predict fitness-to-practise sanctions because the psychological processes involved in successfully studying, understanding and practising medicine at a high level share similar mechanisms to those underlying conduct and trust.’

Fitness to practise

Professor Chris McManus of the UCL research department of medical education said: ‘Fitness to practise is at the core of being a doctor - one of the most trusted and responsible positions in society. Doctors who are not fit to practise endanger patients and others, and the GMC is understandably strict about such matters, with conduct and trust at the heart of the GMC’s approach.  

‘However, postgraduate examinations are primarily concerned about knowledge and skills, with the exams being set and administered by royal colleges, which are independent of the GMC.

‘Our findings therefore suggest that while attaining the knowledge, skills and competencies for effective and safe medical practice - the apparent emphases of examination - they are implicitly also part of assessing conduct and trust of doctors.’

A GMC spokesperson said: 'This research highlights the challenges that different doctors will face across their careers. It reaffirms our strategy of engaging with doctors earlier and more often to help them achieve and maintain the high standards of care which they want to provide to patients, so that harm to patients - and doctors - can be prevented.'

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