What you should know about the new national exam for medical students
From 2022, anyone who wants to practise medicine in the United Kingdom will have to sit a national exam called the UK Medical Licensing Assessment (UKMLA)
In 2015, the General Medical Council announced that from 2022 medical graduates who want to practise medicine in the UK will have to pass the UK Medical Licensing Assessment (UKMLA).
Current UK graduates are required to pass their medical school’s exams, and overseas graduates are required to pass the Professional and Linguistics Assessment Board (PLAB) test, before the GMC will grant them a licence to practise in the UK.
Although UK medical schools’ curriculums must comply with the GMC’s Outcomes for graduates, the regulator says the new licensing exam will give greater reassurance to the public and create a “common threshold for safe practice.”
After announcing the new exam, the GMC carried out a consultation about its introduction with all UK medical schools in 2016, and also conducted a public consultation from January to April 2017.
This article outlines what is known about the UKMLA so far, and what questions remain unanswered.
Box 1: UKMLA timeline
- June 2015—GMC approves plans for the UKMLA
- September 2016—GMC publishes a report summarising its discussions with UK medical schools about the introduction of the UKMLA
- 31 January to 30 April 2017—the GMC conducts a public consultation
- 2021-22 academic year—first cohort of final year medical students will sit the UKMLA
What we know about the UKMLA
Anyone who wants to start practising as a doctor in the UK from 2022 onwards will have to pass it
The UKMLA will be a single entry test for UK graduates, international graduates, and doctors from overseas who wish to practise medicine in the UK. Candidates sitting the exam will be given either a pass or fail mark.
It will be a test of medical knowledge and clinical skills
The exam is likely to consist of a “test of applied knowledge” (multiple choice questions), “a test of clinical and professional skills” (objective structured clinical exam [OSCE]), and questions about healthcare and law in the UK.
It will be integrated into medical school finals
The GMC says that by the end of its consultation with medical schools it had concluded that the UKMLA should be integrated into medical school finals, rather than being a standalone exam conducted on the same day for all candidates.
UK medical students won’t have to pay to sit the exam
When the UKMLA was announced, students were concerned that they might have to pay to travel to and sit the exam. The GMC says UK medical schools will most likely bear the cost for students. However, candidates from overseas will pay to sit the UKMLA themselves.
The prescribing safety assessment (PSA) will be absorbed into the UKMLA, but the situational judgement test (SJT) will remain a separate exam
The GMC says that the PSA is likely to be integrated into the UKMLA because “being able to prescribe is fundamental for a doctor to hold a licence to practise.” The regulator says that the SJT will remain a standalone assessment because its results are used to rank students for training places, not to assess their ability to practise medicine safely.
What we don’t know about the UKMLA
How will the exam be replicated and assessed?
Although we know that the UKMLA will be a mix of assessment styles, it is unclear how the GMC will be able to accurately replicate OSCE conditions across different sites on different days. There is also uncertainty around what the pass mark will be, and how easy it will be to re-sit the exam if you fail.
How will it change the identity of medical school curriculums?
Currently, medical schools pride themselves on their individual approaches to teaching medicine, but the UKMLA could start to squeeze out these differences as schools become focused on making sure their students pass the test. Also, medical students may become fixated on passing the UKMLA as a means to an end. However, in countries where a national licensing exam already exists, these concerns have not become a reality.
Will it increase competition between medical schools and between students?
The GMC admits that it will be possible to rank each student on the basis of their performance in the exam, but it is unclear whether this information will be shared with medical schools or the public. Introducing league tables of performance in the UKMLA could increase competitiveness between medical schools, and they might start marketing themselves as institutions that offer prospective students a higher chance of passing the UKMLA.
Will the UKMLA be linked to workforce planning?
The UKMLA could be used to test competencies that are more aligned with undersubscribed specialties, such as general practice and psychiatry. In a BMJ Careers article from 2014, Chris Williams (a GP from Scotland) said, “I believe there will be some recognition [in the UKMLA] that doctors need to understand more about primary care than they have done at some of our medical schools in the past.”
What about the point of registration?
In 2013, a government review of UK medical training suggested that the point of full GMC registration should be moved to the end of medical school, rather than after the first year of foundation training. There has been no movement on this issue since the recommendation was made, but the introduction of the UKMLA may present an opportunity to finally make this switch. The GMC also intends to “set an early revalidation date for newly licensed doctors so that they receive their first revalidation date within two years of commencing practice in the UK.” For this plan to become a reality, the point of full registration will need to be moved to graduation from medical school, which would also coincide with final year medical students passing the UKMLA.Laura Elliott, foundation year one doctor
Queen Elizabeth Hospital, London, UK
Competing interests: None declared
Provenance and peer review: Not commissioned; not externally peer reviewed.
- General Medical Council. GMC Council approves development of UK medical licensing assessment. 2015. www.gmc-uk.org/news/26549.asp.
- General Medical Council. Outcomes for graduates. 2017. www.gmc-uk.org/education/undergraduate/undergrad_outcomes.asp.
- General Medical Council. Medical Licensing Assessment. 2017. www.gmc-uk.org/education/29000.asp.
- General Medical Council. Working together to develop a medical licensing assessment: findings from our engagement with UK medical schools. 2016. www.gmc-uk.org/Report_of_MLA_visits_to_medical_schools_v1.0.pdf_68172878.pdf.
- General Medical Council. Securing the licence to practise: introducing a Medical Licensing Assessment—a public consultation. 2016. www.gmc-uk.org/MLA_consultation_document_English_writeable_distributed.pdf_69151379.pdf.
- Hateley P. A new national exam for medical students. Student BMJ 2015;23:h4208.
- Rimmer A. Is a single national licensing exam for doctors a good idea? BMJ Careers 2014; 25 November. http://careers.bmj.com/careers/advice/view-article.html?id=20020182.
- Shape of Training. Securing the future of excellent patient care. 2016. www.shapeoftraining.co.uk/static/documents/content/Shape_of_training_FINAL_Report.pdf_53977887.pdf.