Are national qualifying examinations a fair way to rank medical students? No

Much has been made of the lack of standardisation within UK medical schools as a result of a recent research paper.1 The authors called for a national licensing examination after they found that medical schools had significantly different pass rates for the Royal College of Physicians postgraduate examinations. However, these exams are for progression in higher training and not a test of the accepted level of competence to practise as a foundation doctor. There is no evidence that UK medical schools are not currently fulfilling their responsibilities of ensuring that students who reach the required standard to qualify as doctors are fit to practise. Indeed, in a 2005 survey of postgraduate deans, only three UK graduates out of 5833 first year doctors caused concern relating to clinical competence.2