UK nationals who received their medical degrees abroad: selection into, and subsequent performance in postgraduate training: a national data linkage study

Abstract

Objectives: To compare the likelihood of success at selection into specialty training for doctors who were UK nationals but obtained their primary medical qualification (PMQ) from outside the UK ('UK overseas graduates') with other graduate groups based on their nationality and where they gained their PMQ. We also compared subsequent educational performance during postgraduate training between the graduate groups.

Design: Observational study linking UK medical specialty recruitment data with postgraduate educational performance (Annual Review of Competence Progression (ARCP) ratings).

Setting: Doctors recruited into national programmes of postgraduate specialist training in the UK from 2012 to 2016.

Participants: 34 755 UK-based trainee doctors recruited into national specialty training programmes with at least one subsequent ARCP outcome reported during the study period, including 1108 UK overseas graduates.

Main outcome measures: Odds of being deemed appointable at specialty selection and subsequent odds of obtaining a less versus more satisfactory category of ARCP outcome.

Results: UK overseas graduates were more likely to be deemed appointable compared with non-EU medical graduates who were not UK citizens (OR 1.29, 95% CI 1.16 to 1.42), although less so than UK (OR 0.25, 95% CI 0.23 to 0.27) or European graduates (OR 0.66, 95% CI 0.58 to 0.75). However, UK overseas graduates were subsequently more likely to receive a less satisfactory outcome at ARCP than other graduate groups. Adjusting for age, sex, experience and the economic disparity between country of nationality and place of qualification reduced intergroup differences.

Conclusions: The failure of recruitment patterns to mirror the ARCP data raises issues regarding consistency in selection and the deaneries' subsequent annual reviews. Excessive weight is possibly given to interview performance at specialty recruitment. Regulators and selectors should continue to develop robust processes for selection and assessment of doctors in training. Further support could be considered for UK overseas graduates returning to practice in the UK.

Keywords: international medical graduates; medical regulation; medical selection.

Figure 1

Flow of data through the study. ARCP, Annual Review of Competence Progression; PLAB, Professional and Linguistic Assessments Board; PMQ, primary medical qualification.

Figure 2

Results from univariable and multivariable analyses for an individual being deemed ’appointable' for each graduate group in comparison to UK graduates. EEAG, European Economic Area graduate; IMG, international medical graduate.

Figure 3

Results by specialty for UK overseas graduates being deemed ’appointable' vs UK graduates.

Figure 4

Univariable and multivariable ARCP results for all specialties for each graduate group in comparison to UK graduates. ARCP, Annual Review of Competence Progression; EEAG, European Economic Area graduate; IMG, international medical graduate; UK OG, UK overseas graduate.

Figure 5

Univariable and multivariable odds ratios for receiving a less satisfactory vs a more satisfactory ARCP outcome. The results are shown only for UK overseas graduates vs UK graduates, by specialty. ARCP, Annual Review of Competence Progression.