Language of primary medical qualification and differential MRCGP exam attainment: an observational study.

Abstract

Background: International medical graduates (IMGs) comprise more than half of GP registrars but are more likely to fail postgraduate assessments than UK graduates.

Aim: To assess whether there is an association between the language of the primary medical qualification (PMQ) and Membership of the Royal College of General Practitioners (MRCGP) results, and whether performance in previous prequalification assessments is correlated.

Design and setting: Retrospective observational study in the UK.

Method: The World Directory of Medical Schools and the UK Medical Education databases were used to obtain data for all candidates who sat the MRCGP exams between October 2013 and July 2021 (n = 28 020). Candidates were split into three cohorts: cohort 1 comprised UK graduates; cohort 2 comprised IMGs with English as the language of the PMQ, who trained in countries with English (cohort 2a) or non-English (cohort 2b) as a first language; and cohort 3 included IMGs with non-English as the language of the PMQ. Logistic and linear regression analyses were used to compare the odds of exam passing and the scores relative to pass. Associations with past Multi-Specialty Recruitment Assessment (MSRA) scores, International English Language Testing System (IELTS) scores, and Professional and Linguistic Assessments Board (PLAB) scores were examined.

Results: IMGs who trained in countries with non-English as a first language had statistically significantly lower odds of passing the exams and lower exam scores across all exam components. There were statistically significant positive correlations between MRCGP exam scores and MSRA, IELTS, and PLAB scores.

Conclusion: English being the language of the PMQ and undertaking medical training in a country with English as the native language seemed to result in statistically significantly better chances of passing the exams and better exam scores. Performance in prequalification assessments can help to identify those IMG registrars who may benefit from tailored support.