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Annual Review of Competence Progression (ARCP) performance of doctors who passed Professional and Linguistic Assessments Board (PLAB) tests compared with UK medical graduates: national data linkage study

BMJ 2014; 348 doi: (Published 17 April 2014) Cite this as: BMJ 2014;348:g2622

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  1. Paul A Tiffin, clinical senior lecturer1,
  2. Jan Illing, professor of medical education2,
  3. Adetayo S Kasim, research statistician3,
  4. John C McLachlan, professor of medical education2
  1. 1School for Medicine, Pharmacy and Health, Wolfson Research Institute for Health and Wellbeing, Durham University Queen’s Campus, Stockton-on-Tees TS17 6BH, UK
  2. 2Centre for Medical Education Research, Burdon House, Leazes Road, Durham DH1 1TA, UK
  3. 3Wolfson Research Institute for Health and Wellbeing, Durham University Queen’s Campus, Stockton-on-Tees TS17 6BH, UK
  1. Correspondence to: P Tiffin p.a.tiffin{at}
  • Accepted 3 April 2014


Objective To determine whether use of the Professional and Linguistic Assessments Board (PLAB) examination system used to grant registration for international medical graduates results in equivalent postgraduate medical performance, as evaluated at Annual Review of Competence Progression (ARCP), between UK based doctors who qualified overseas and those who obtained their primary medical qualification from UK universities.

Design Observational study linking ARCP outcome data from the UK deaneries with PLAB test performance and demographic data held by the UK General Medical Council (GMC).

Setting Doctors in postgraduate training for a medical specialty or general practice in the UK and doctors obtaining GMC registration via the PLAB system.

Participants 53 436 UK based trainee doctors with at least one competency related ARCP outcome reported during the study period, of whom 42 017 were UK medical graduates and 11 419 were international medical graduates who were registered following a pass from the PLAB route.

Main outcome measure Probability of obtaining a poorer versus a more satisfactory category of outcome at ARCP following successful registration as a doctor in the UK.

Results International medical graduates were more likely to obtain a less satisfactory outcome at ARCP compared with UK graduates. This finding persisted even after adjustment for the potential influence of sex, age, years of UK based practice, and ethnicity and exclusion of outcomes associated with postgraduate examination failure (odds ratio 1.63, 95% confidence interval 1.30 to 2.06). However, international medical graduates who scored in the highest twelfth at part 1 of the PLAB (at least 32 points above the pass mark) had ARCP outcomes that did not differ significantly from those of UK graduates.

Conclusions These findings suggest that the PLAB test used for registration of international medical graduates is not generally equivalent to the requirements for UK graduates. The differences in postgraduate performance, as captured at ARCP, following the two routes to registration might be levelled out by raising the standards of English language competency required as well as the pass marks for the two parts of the PLAB test. An alternative might be to introduce a different testing system.


  • We thank Andy Knapton and Thomas Jones at the GMC for their assistance with obtaining the data used in this study. We are especially grateful to Daniel Smith at the GMC for his work on data preparation and other assistance offered. We also thank Indranil Chakrabarti for his comments and feedback on an earlier draft of this manuscript.

  • Contributors: PAT led on conception, design, statistical analysis, and interpretation of data. JI contributed to the study conception and design, literature review, drafting and revising of the article, and critically appraising the content. ASK supervised the statistical analysis and contributed to interpreting the results. JCMcL contributed to the study conception and design, literature review, drafting and revising of the article, and critically appraising the content. All authors have approved the final version of the article submitted. PAT is the guarantor.

  • Funding: This study was funded by the General Medical Council (GMC) via an open tendering process. All authors are independent of the GMC. PAT is supported in his research by a Higher Education Funding Council for England (HEFCE) clinical senior lecturer fellowship.

  • Competing interests: All authors have completed the ICMJE uniform disclosure form at and declare: no support from any organisation for the submitted work; no financial relationships with any organisations that might have an interest in the submitted work in the previous three years; no other relationships or activities that could have influenced the submitted work.

  • Ethical approval: Not required. The study relied on the analysis of de-identified routinely collected data. This was confirmed in writing by the chair of the Durham University School for Medicine, Pharmacy and Health Ethics Committee.

  • Declaration of transparency: The lead author (PAT) affirms that this manuscript is an honest, accurate, and transparent account of the study being reported; that no important aspects of the study have been omitted; and that any discrepancies from the study as planned (and, if relevant, registered) have been explained.

  • Data sharing: No additional data available.

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