It may come as a surprise to many of our colleagues outside the UK (and our patients) that the UK has never had a nationwide examination for final year medical students before they qualify as doctors. However, this is about to change with the introduction of the Medical Licensing Assessment (MLA).
Whilst many postgraduate training programmes are becoming less prescriptive about their syllabus and focus more on ‘specialty learning outcomes’, the MLA attempts to detail just what clinical presentations medical students should know about.
Much of the information below is taken directly from the GMCs website
The UK’s medical schools and parent universities have agreed to develop and deliver the Medical Licensing Assessment (MLA) that will be embedded within final exams for a UK medical degree.
A process of phased introduction will begin from 2021 with robust testing and piloting, and the assessment will be fully implemented for students graduating from UK medical schools from the academic year 2024/25.
To date UK medical schools have set their final exams independently in line with the GMC’s Outcomes for graduates. In essence each medical school was able to set it’s own examinations with relatively little external input. The major benefit of the MLA is that it will, for the first time, be possible to demonstrate that graduates from each medical school have met an agreed standard of proficiency and are well prepared to practise medicine as Foundation Year doctors. The MLA will provide assurance that anyone who obtains a UK medical degree has shown that they can meet a common and consistent threshold for safe practice before they are licensed to work in the UK.
For their part the GMC will:
- Define the range of professional skills, knowledge and behaviours a candidate needs to have achieved to be ready to practise medicine in the UK;
- Approve procedures to compile test questions and papers, set standards and run exams;
- Take corrective action if, through its quality assurance processes, it considers that standards are not met;
- Be responsible for using information and data from the UK exams to apply a consistent approach to the assessment of international medical graduates.
Under this agreement UK university medical schools will continue to develop and deliver their own curricula and prepare students for the MLA which will be regulated by the GMC.
The Medical Licensing Assessment (MLA)
The exam will consist of two parts – an applied knowledge test (AKT), and a clinical and professional skills assessment (CPSA).
The Applied Knowledge Test (AKT)
The AKT that is centrally set for all UK medical schools with a common format, test standard, delivery process and policy framework.
This is planned to be an on-screen exam, run by the medical schools, with multiple choice questions. It will test students ability to apply medical knowledge to different scenarios.
Clinical and Professional Skills Assessment (CPSA)
This is an assessment of clinical skills and professional skills, which medical schools will set and run. The GMC has produced guidelines (and there is ongoing consultantation) about how these may function.
Each medical school calls the CPSA something different – for example, an Objective Structured Clinical Examination (OSCE) or Objective Structured Long Examination Record (OSLER).
The latest GMC guidance on the CPSA is here.
The MLA Content Map
The MLA content map sets out the core knowledge, skills and behaviours that have been determined are needed for UK practice. All applied knowledge test (AKT) and clinical and professional skills assessment (CPSA) content will derive from the content map
The content map is based on Outcomes for graduates (2018), the Generic professional capabilities framework (2017), the relevant parts of the Foundation Programme curriculum and the situations typically faced by doctors working in the UK Foundation Programme.
It has three overarching themes: readiness for safe practice, managing uncertainty, and delivering person-centred care; and six sections, called domains:
- Areas of clinical practice, such as mental health and surgery.
- Areas of professional knowledge, such as biomedical sciences and medical ethics and law.
- Clinical and professional capabilities, such as assessing and managing risk and safeguarding vulnerable patients.
- Practical skills and procedures, as set out in the list of practical skills and procedures that supplements our Outcomes for graduates (2018).
- Patient presentations, which relates to signs, symptoms, investigation results and other relevant patient-related issues typically seen by doctors in a first appointment within the UK Foundation Programme. For example, a chronic rash or breast lump. These presentations have been mapped to areas of clinical practice and, unsurprisingly, it is the section on ‘Acute and Emergency Care‘ that we have foccused on.
- Conditions, which are pathophysiological diseases or clinical diagnoses typically seen by doctors in a first appointment within the UK Foundation Programme. For example, asthma and eating disorders.
St Emlyn’s Undergraduate Acute and Emergency Care Curriculum
At St Emlyn’s we are keen to help students to prepare for this assessment (and life as doctors). To that end we have developed the “St Emlyn’s Undergraduate Acute and Emergency Care Curriculum“.
This focuses on all of the MLA content map presentations for acute care. We have added what we believe to be reasonable knowledge and skills for medical students to be assessed on within acute and emergency care, to help guide both learners and trainers during clinical placements.
It is important to note that these are merely our thoughts and do not represent an official curriculum from the GMC.
Below each suggested set of learning outcomes we have added links to recommended specific resources, that will help students both to gain the foundation of the knowledge required but also include further reading extending their expertise. All of these resources are open access and will give the learner a superb knowledge base on which to build in their clinical placement. We hope that these resources will not only educate, but also inspire the student to explore acute and emergency care more.
Whilst preparing the curriculum and links to resources I have been reminded of the astonishing array of high quality medical education websites. Below are links to the homepage of each. We all owe a huge debt of gratitude to all of those who spend hours preparing and maintaining these fantastic websites.