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Getting to grips with the new Medical Licensing Assessment

Published on: 10 Jan 2024

 Medical Licensing Assessment (MLA)

The General Medical Council (GMC) is changing the way that doctors join the UK medical register. Beginning in 2024, all students graduating from UK medical schools and doctors who qualified abroad and currently take the Professional and Linguistic Assessments Board (PLAB) to work in the UK will need to pass a new assessment – the Medical Licensing Assessment (MLA). BMJ Careers looks at the GMC and Medical Schools Council’s plans.

 

Why is the registration process changing?

By introducing the MLA, the GMC is seeking to introduce a threshold for safe medical practice, and improve fairness and consistency in how UK students and international medical graduates are tested prior to joining the medical register.

 

How are doctors currently registered to practise in the UK?

Currently, UK medical students apply for provisional registration in the final year of their medical degree. This allows them to move to the first year of the Foundation Programme (F1). On completion of F1, they apply for full registration with the GMC to move on to the second year of the foundation programme (F2). Meanwhile, most medical graduates trained outside the UK, European Economic Area (EEA) or Switzerland must pass the PLAB test, which – alongside some other requirement such as demonstrating proficiency in English – allows them to apply for full registration.

 

When will the MLA be introduced?

In 2024. From the academic year 2024-25, the MLA will be incorporated into the final exams of all UK medical degrees. Some medical schools deliver final exams in the penultimate year of study, so these schools will deliver the MLA in the 2023-24 academic year. The PLAB test for international doctors will be amended to meet the MLA requirements during 2024. International candidates will be told 3 months ahead of their PLAB 1 or 2 test whether it will be based on the PLAB Blueprint or the MLA content map. The test will continue to be called the PLAB for the moment, although it will be renamed at a later date.

 

So, will all UK and international candidates now sit the same exams?

No, UK and international candidates will continue to take the same sets of exams as they have done previously. However, the exams they take from 2024 will draw on the same topics set out in the MLA content map, but the specific questions will reflect the different levels of experience and training of the two groups. Students at UK medical schools will take the MLA as undergraduates, while international candidates will generally have completed an internship that is equivalent to the first year of the Foundation Programme.

 

Does that mean that the exams taken by international candidates will be more challenging than those taken by UK candidates?

Yes, because the MLA will assess UK and international candidates at different stages of training. The MLA will assess whether UK students have the knowledge, skills and behaviours for provisional registration and F1 training, and whether international graduates have them for full registration. The two cohorts will therefore require different levels of challenge.

 

Will all international graduates have to pass the MLA?

Under current legislation, medical graduates with a relevant European qualification awarded in an EEA country or Switzerland will not need to take the assessment. There will also continue to be other routes to UK registration for international doctors, including sponsorship, specialist registration, and acceptable postgraduate qualifications. The GMC has produced a tool to help international doctors to identify which route is most appropriate to their circumstances.

 

What will the new Medical Licensing Assessment involve?

The Medical Licensing Assessment will consist of a two-part assessment to determine that candidates have the knowledge, skills and experience needed for safe medical practice, including the ability to manage uncertainty and deliver patient-centred and safe care. The two-part assessment will involve:

  1. An Applied Knowledge Test (AKT) – For UK candidates this will be a 200-item on-screen exam. The exam will be split into two 2-hour papers across two consecutive days, and all questions will be single-best answer format with five options. For international candidates, the AKT will be delivered through PLAB 1. PLAB 1 is currently a 3-hour, paper-based exam of 180 multiple choice questions, and its format is not expected to change when the PLAB becomes MLA compliant.   
  2. A Clinical and Professional Skills Assessment (CPSA) – An in-person examination of clinical and professional skills which follows the Objective Structured Clinical Examination (OSCE) format. This will be set and delivered by UK medical schools for candidates in the UK, and via PLAB 2 for international candidates. The current format of PLAB 2 is 16 stations of 8-minute scenarios plus 2 rest stations, and this is not expected to change when PLAB becomes MLA compliant. 

The GMC has created an MLA content map which sets out the core knowledge, skills and behaviours needed for UK practice. All content, from either part of the MLA, will derive from the MLA content map. The MLA content map is based on the GMC’s Outcomes for Graduates and Generic Professional Capabilities Framework, and situations typically faced by doctors working in the UK Foundation Programme.

 

What does the MLA content map cover

This MLA content map sets out competencies expected of a newly registered doctor about to enter the UK Foundation programme across the following six domains.

 MLA content map

 

Will candidates at all UK medical schools sit the same exams?

No. The Medical Schools Council is working with medical schools to develop a UK-wide AKT. AKT exam papers will be set centrally and delivered locally by schools. Every academic year there will be a number of AKT papers in use and these will be assigned across medical schools by the Medical Schools Council. Medical schools are working individually to develop their CPSAs.

 

Where will international students take the assessment?

International medical graduates will take the AKT component, as they currently take part 1 of the PLAB test, at a range of international locations. They’ll take the CPSA component as they currently take part 2 of the PLAB test, at the GMC’s clinical assessment centre in Manchester. The PLAB exam will be renamed at a later date.

 

How much does it cost to take the Medical Licensing Assessment?

Nothing for students at UK medical schools to take the exam initially, but some schools will charge for resits. For international candidates, the cost will be consistent with current PLAB fees. From 1 April 2023 the fee for PLAB 1 was £255 and the fee for PLAB 2 was £934.

 

How will the standard of the MLA compare to existing exams?

One of the aims of the MLA is to set a threshold for medical practice, and improve fairness and consistency in how UK and international students are tested. Any variations in standards across UK medical school finals should be reduced, and the standard of the PLAB will not change when it becomes MLA compliant. 

 

What will be the pass mark/pass rate?

A pass mark will be set for each individual exam based on internationally recognised criteria to ensure standards are consistent over time. There is no blanket static mark or proportion of candidates.

 

What happens when you pass?

Students at UK schools need to apply to the GMC for provisional registration during their final year of study, and this is granted once their medical schools confirm they have graduated and therefore passed the MLA. International candidates need to provide a range of information before registration can be granted. This includes verification of their primary medical qualification, details of postgraduate work experience, and evidence of proficiency in English.

 

What happens if you fail?

You can resit the assessment. International candidates can currently resit the PLAB 1 and PLAB 2 a maximum of four times for each test, with a further final resit possible 12 months later if the candidate can provide evidence that additional learning has taken place. International candidates need to pay for each test that they book and the resit policy is not expected to change once the PLAB becomes MLA compliant. Resit policies, including any resit costs, for students at UK medical schools are set by individual universities.

 

Can I get help to practise for the Medical Licensing Assessment?

For students at UK medical schools, their degree course is designed to be their preparation for the MLA, so they should speak to their medical school first if they feel they need additional support or advice. The Medical Schools Council has produced some detailed guidance for candidates preparing for the MLA as part of their UK medical school finals, including a handbook on the changes, guidance on the minimum number of questions across specific clinical domains that will appear in each AKT paper sat by UK candidates, and a full practice AKT exam with answers. International candidates should refer to the GMC’s PLAB guides for help and support, which contain sample questions for PLAB 1 and PLAB 2

Candidates can practise for the AKT using BMJ OnExamination’s MLA resource which includes more than 2,000 questions across the six domains tested by the MLA. BMJ Careers has a useful article on Tips For Answering Single Best Answer Exam Questions.

 

Further information