Mehdizadeh L, Potts H W W, Sturrock A, Dacre J
University College London Medical School, Royal Free Hospital, room GF/664, Hampstead, London, NW3 2PF, UK.
UCL Institute of Health Informatics, 222 Euston Road, London, NW1 2DA, UK.
BMC Med Educ. 2017 Apr 4;17(1):67. doi: 10.1186/s12909-017-0903-6.
The demographics of doctors working in the UK are changing. The United Kingdom (UK) has voted to leave the European Union (EU) and there is heightened political discourse around the world about the impact of migration on healthcare services. Previous work suggests that foreign trained doctors perform worse than UK graduates in postgraduate medical examinations. We analysed the prevalence by country of primary medical qualification of doctors who were required to take an assessment by the General Medical Council (GMC) because of performance concerns.
This was a retrospective cohort analysis of data routinely collected by the GMC. We compared doctors who had a GMC performance assessment between 1996 and 2013 with the medical register in the same period. The outcome measures were numbers experiencing performance assessments by country or region of medical qualification.
The rate of performance assessment varied significantly by place of medical qualification and by year; χ (17) = 188, p < 0.0001, pseudo-R = 15%. Doctors who trained outside of the UK, including those trained in the European Economic Area (EEA), were more likely to have a performance assessment than UK trained doctors, with the exception of South African trained doctors.
The rate of performance assessment varies significantly by place of medical qualification. This is the first study to explore the risk of performance assessment by individual places of medical qualification. While concern has largely focused on the competence of non-EEA, International Medical Graduates, we discuss implications for how to ensure European trained doctors are fit to practise before their medical licence in the UK is granted. Further research is needed to investigate whether these country effects hold true when controlling for factors like doctors' sex, age, length of time working in the UK, and English language skills. This will allow evidence-based decisions to be made around the regulatory environment the UK should adopt once it leaves the EU. Patients should be reassured that the vast majority of all doctors working in the UK are competent.
在英国工作的医生的人口统计学特征正在发生变化。英国已投票决定退出欧盟，全球围绕移民对医疗服务的影响展开了激烈的政治讨论。此前的研究表明，在研究生医学考试中，外国培养的医生表现不如英国毕业生。我们分析了因表现问题而被英国医学总会（GMC）要求进行评估的医生按初始医学资格国家划分的患病率。
这是一项对GMC常规收集的数据进行的回顾性队列分析。我们将1996年至2013年期间接受GMC表现评估的医生与同期的医学注册记录进行了比较。结果指标是按医学资格国家或地区划分的接受表现评估的人数。
表现评估率因医学资格地点和年份的不同而有显著差异；χ(17)=188，p<0.0001，伪R=15%。在英国以外地区接受培训的医生，包括在欧洲经济区（EEA）接受培训的医生，比在英国接受培训的医生更有可能接受表现评估，但南非培养的医生除外。
表现评估率因医学资格地点的不同而有显著差异。这是第一项按个别医学资格地点探讨表现评估风险的研究。虽然人们主要关注的是非欧洲经济区国际医学毕业生的能力，但我们讨论了如何确保在英国授予欧洲培养的医生行医执照之前他们具备行医资格的相关影响。需要进一步研究，以调查在控制医生的性别、年龄、在英国工作的时间长度和英语语言技能等因素后，这些国家效应是否仍然成立。这将有助于在英国脱欧后就应采用的监管环境做出基于证据的决策。应让患者放心，在英国工作的绝大多数医生都是称职的。
