Foundation year for newly qualified doctors

Editor—In his article on the new UK foundation programme, Hays says that assessment will focus on practical aspects of medical work rather than examinations.¹ An examination already exists, however, that is explicitly set to correspond with the level of knowledge expected of a doctor at the end of foundation year 1.

This is the Professional and Linguistic Assessment Board Test (PLAB), administered by the General Medical Council to assess whether international medical graduates have the ability to practise safely as senior house officers in UK hospitals.² It takes the form of a written paper (part 1) and an objective, structured, clinical examination (part 2). Pass marks for the part 1 extended matching question (EMQ) examinations in 2004 ranged from 59.6% to 65.5% (Jo Mullin, GMC PLAB test section, personal communication, 2004).

We conducted an audit of UK graduates taking up senior house officer posts in accident and emergency medicine at a major London teaching hospital. A paper comprising 50 extended matching questions was derived from a popular PLAB revision aid³,⁴ and then edited by an experienced former PLAB examiner to confirm that it accurately reflected the standard of the PLAB examination. Twenty eight senior house officers sat the test in November 2004 and March 2005. Only four scored less than 60% (mean mark 64%, SD 11%) but, of these, two scored only 38% and 40%—well below the pass mark and more than 2 standard deviations below the mean.

How many doctors completing the foundation programme would be found wanting if tested by this benchmark? We think there is a strong case for a PLAB style examination to form part of the assessment process for both foundation years, thereby providing a level playing field for UK and international medical graduates. Alternatively, if examinations are no longer thought to relevant, the PLAB assessment should be revised.