UK nationals who study medicine abroad are more likely to perform poorly as doctors in training

10 August 2018

UK nationals who study medicine abroad are more likely to perform poorly as doctors in training

A major new study suggests that UK nationals who obtain their medical degrees abroad are more likely to perform poorly during training when they return home to work in the NHS.

However, they stand a better chance of being offered a place on a training programme than non-EU medical graduates who are not UK citizens.

The researchers, from the University of York, are now calling for a fairer selection and assessment process for doctors in training and for more support for UK overseas graduates returning to practice in the UK to be considered.

Dr Paul Tiffin, from the Department of Health Sciences at the University of York and the Hull York Medical School, said:

Our study suggests that UK nationals who study medicine abroad are more likely than international medical graduates who are foreign nationals to be offered a place on a specialty programme. However, once in training, they perform, on average, more poorly than other graduate groups of doctors.

“This may be happening because excessive weight is being given to interview performance during the selection process, giving a disproportionate advantage to those who speak English as a first language.

“Further support for UK overseas graduates returning to practice in the UK should be considered as those who experience their undergraduate training in another country may be less well prepared to work in the UK health services. However, as they are UK citizens they may not stand out as needing such extra help with this transition, unlike their non-UK counterparts.”

Over the past few years, there has been a surge in the number of UK citizens travelling abroad to study for a medical degree.

Approximately 3-4% of NHS doctors in training are UK citizens who got their medical degree outside of the country.

UK citizens choose to study abroad for a variety of reasons – some may not have been able to secure a place to study medicine in the UK, but other motivating factors include tuition costs and family links.

The study looked at nearly 35,000 UK-based trainee doctors, 1108 of which were UK overseas graduates.

The researchers took UK medical speciality recruitment data and linked it with postgraduate educational performance by analysing the results of exams taken in each year of speciality training, known as Annual Review of Competence Progression.

On average, the UK overseas graduates had more attempts and achieved lower scores than non-EU medical grads who are not UK citizens in phase one of testing on speciality training.

A previous study noted that a group of UK overseas graduates training to be GPs also performed more poorly on the knowledge-based component of the Membership of the Royal College of General Practitioners exam (MRCGP) at the end of training.  Interestingly, there was no difference in achievement in the clinical assessment part of the MRCGP that simulates real medical practice.

Consequently, it is unknown whether this exam achievement gap can be taken as an indication that UK overseas graduates will not do as well as other medical practitioners when it comes to treating actual patients.

Dr Tiffin added: “We do not know whether British who qualify overseas have, on average, worse patient outcomes than other medical graduate groups– although studies of American citizens who study medicine outside the US have suggested this may be the case.”

“Ultimately, the right to practice medicine should not be based on nationality or place of qualification of an individual, but on reliable and fair evaluation of clinical ability in that specific national context.”

UK nationals who received their medical degrees abroad: selection into, and subsequent performance in postgraduate training: a national data linkage study is published in the journal BMJ Open.