Intended for healthcare professionals


Doctors trained outside the UK are more likely to be assessed by the GMC, say researchers

BMJ 2017; 357 doi: (Published 11 April 2017) Cite this as: BMJ 2017;357:j1841
  1. Abi Rimmer
  1. BMJ Careers
  1. arimmer{at}

Doctors trained outside of the UK are more likely to undergo performance assessments with the General Medical Council than doctors trained in the UK, researchers have found.1

Researchers from University College London found that doctors who trained in Bangladesh were 13 times more likely to have a performance assessment than UK graduates, while doctors trained in Nigeria or Egypt were eight times more likely to be assessed.

The GMC can conduct a performance assessment if concern has been raised about an aspect of a doctor’s performance, such as a basic lack of knowledge, poor clinical judgment, inappropriate prescribing, tendency to use outdated techniques, or poor record keeping.

By analysing GMC data for the years between 1996 and 2013, the researchers found that—with the exception of those trained in South Africa—foreign trained doctors were more likely to undergo a performance assessment than those trained in the UK.

In a paper published in BMC Medical Education, the researchers found that those who trained in the European Economic Area were over four times more likely to have a performance assessment than UK graduates. German trained doctors were over-represented among this group.

Henry Potts, one of the authors of the paper and a senior lecturer at the UCL Institute of Health Informatics, said that there were a number of reasons why doctors who trained outside the UK might be more likely to face a performance assessment.

“It could be bias in the system: we know that is a problem. It could simply reflect other demographic factors—overseas trained doctors are more likely to be men and male doctors, for reasons we are also investigating, are much more likely to get into these procedures. Likewise, it could be about older doctors. It could be about doctors in particular specialties.”

Potts said that it was important to remember that the doctors who underwent performance assessments were not representative of all doctors trained in the same country. Also, the number of doctors going through assessment procedures was small, Potts said. “For example Bangladesh has the highest rate of performance assessments, but that is only 23 doctors over a 17 year period.”


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