Fitness to practise sanctions in UK doctors are predicted by poor performance at MRCGP and MRCP(UK) assessments: data linkage study

Background

The predictive validity of postgraduate examinations, such as MRCGP and MRCP(UK) in the UK, is hard to assess, particularly for clinically relevant outcomes. The sanctions imposed on doctors by the UK’s General Medical Council (GMC), including erasure from the Medical Register, are indicators of serious problems with fitness to practise (FtP) that threaten patient safety or wellbeing. This data linkage study combined data on GMC sanctions with data on postgraduate examination performance.

Methods

Examination results were obtained for UK registered doctors taking the MRCGP Applied Knowledge Test (AKT; n?=?27,561) or Clinical Skills Assessment (CSA; n?=?17,365) at first attempt between 2010 and 2016 or taking MRCP(UK) Part 1 (MCQ; n?=?37,358), Part 2 (MCQ; n?=?28,285) or Practical Assessment of Clinical Examination Skills (PACES; n?=?27,040) at first attempt between 2001 and 2016. Exam data were linked with GMC actions on a doctor’s registration from September 2008 to January 2017, sanctions including Erasure, Suspension, Conditions on Practice, Undertakings or Warnings (ESCUW). Examination results were only considered at first attempts. Multiple logistic regression assessed the odds ratio for ESCUW in relation to examination results. Multiple imputation was used for structurally missing values.

Results

Doctors sanctioned by the GMC performed substantially less well on MRCGP and MRCP(UK), with a mean Cohen’s d across the five exams of ??0.68. Doctors on the 2.5th percentile of exam performance were about 12 times more likely to have FtP problems than those on the 97.5th percentile. Knowledge assessments and clinical assessments were independent predictors of future sanctions, with clinical assessments predicting ESCUW significantly better. The log odds of an FtP sanction were linearly related to examination marks over the entire range of performance, additional performance increments lowering the risk of FtP sanctions at all performance levels.

Conclusions

MRCGP and MRCP(UK) performance are valid predictors of professionally important outcomes that transcend simple knowledge or skills and the GMC puts under the headings of conduct and trust. Postgraduate examinations may predict FtP sanctions because the psychological processes involved in successfully studying, understanding and practising medicine at a high level share similar mechanisms to those underlying conduct and trust.

     

Technology-based vs. traditional instruction. A comparison of two methods for teaching the skill of performing a 12-lead ECG

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Osteoporosis and fragility fractures

The prevalence of osteoporosis is expected to increase with the ageing of the world's population. This article reviews the epidemiology, risk factors and health burden of osteoporosis. In the Global Burden of Disease (GBD) Study 2005, osteoporosis is studied as a risk factor for fracture by considering the bone-mineral-density (BMD) measurement as the continuous exposure variable. We have performed a systematic review seeking population-based studies with BMD data measured by dual-X-ray absorptiometry (DXA). The femoral neck was selected as the unique location and all values were converted into Hologic(?) to enable inclusion of worldwide data for analysis. Provisional results on mean BMD values for different world regions are shown in age breakdowns for males and females 50 years or over, as well as mean T-scores using the young, white, female reference of National Health and Nutrition Examination Survey (NHANES) III. Results show remarkable geographical differences and a time trend towards improvement of the BMD values in Asian and European populations.     

An update on glucocorticoid-induced osteoporosis

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Standards of care for acute and chronic musculoskeletal pain: the Bone and Joint Decade (2000-2010)

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