New GMC Centre to Assess Thousands of Overseas Doctors Each Year

Anna Sayburn

Disclosures

August 07, 2019

In a small, enclosed room an actor sits wearing headphones and watching a screen, a script in front of her. She sighs, coughs and responds to questions from the doctor who, on the other side of the building, is examining a spookily life-like animatronic mannikin.

Next door a storeroom is stacked with assorted body parts – limbs, torsos, heads, breasts, and buttocks – like a set from a horror movie. "We've got every orifice you can think of," observes one of the technicians, as we move swiftly through.

I'm getting a rare glimpse behind-the-scenes at the General Medical Council's brand new, state-of-the-art practical skills assessment centre in Manchester, set up to meet the demand of the thousands of overseas doctors from outside the European Economic Area who wish to obtain a licence to practice in the UK.

Animatronics and Role-play

The actors and animatronics go live this week, when 72 doctors from all over the world will take the PLAB (Professional and Linguistic Assessments Board) part 2 exam. These students have already passed the written PLAB 1 test, which can be taken in any of 23 centres worldwide, before heading for Manchester and the practical exam.

The logistics are startling. Each 3 hour and 10 minute exam consists of 18 clinical scenarios, with candidates making their way around a circuit of rooms in the course of each exam. The new centre will allow for two circuits to be run simultaneously, morning and afternoon, doubling the number of assessments possible each day. Up to 45 role-playing actors and 36 examiners will be involved in the testing of 72 doctors a day, as well as invigilators and the chief examiner.

During our visit, we are continually reminded of the 8 minute time limit for each scenario, with automated reminders to finish up and go to the next room. There is clearly little room for error.

Examiner Faisal Parvez, an NHS consultant who is also vice-chair of the PLAB 1 board, was confident that all would go smoothly. "When I first came in as an examiner I was struck by how well run and organised everything was. There is no ambiguity – it is very well structured and timed," he said.

Is he looking forward to working at the new centre? "Definitely – it's lovely. The space – there's much more space than in the previous one. Also the light, particularly the rooms with natural light, which helps put candidates at their ease."

GMC staff will be on hand to shepherd the candidates from one room to the next. In each, they will be met by an examiner, and either an animatronic model or an actor (or sometimes both). The exam is aimed at the level of a UK Foundation Year 2 doctor on their first day, with a mixture of primary and secondary care scenarios.

Life-threatening and 'Mundane' Cases

Some scenarios present life-threatening situations, such as the animatronic model presenting with difficulty breathing, being voiced by the actor we met at the start of the tour. The model is hooked up to a vital signs display monitor, which the doctor needs to check and assess. The doctor can then 'examine' the patient – the model produces appropriate pulses and breathing sounds – and 'talk' to the patient, confirming history and checking symptoms. All the while the doctor explains their findings and plan of action to the examiner.

Other scenarios are more mundane, such as a routine pregnancy check or a breast examination, and the doctor will need to demonstrate good communication skills and a professional attitude, as well as clinical acumen and care for the patient's safety.

For the breast exam, the actors may 'wear' the breast models that will be examined by the doctor. "We used to have male actors wearing them while the doctors talked to the female actor, but that got a bit confusing," said one actor.

Robust and Rigorous Tests

Jane Durkin, the GMC's assistant director of registration, said the PLAB 2 exam provides "a series of robust and rigorous tests" to ensure standards are met.

"Doctors from overseas make an important and valuable contribution to UK health services. This new centre is part of our commitment to support them through our registration process in their quest to practise medicine in the UK. But it is also vital that doctors coming to work in the UK meet the high standards we require and that patients rightly expect." In 2018, 66% of candidates passed PLAB 2.

The previous Manchester centre carried out 5229 PLAB 2 assessments in 2018, with candidates from 122 countries. Nigeria, Pakistan, and India were the top 10 countries. The new centre is purely a response to increasing demand, said Richard Hankins, head of assessment.

"Demand really started to increase in 2015 and at an accelerating rate in 2017 – 2018. The single circuit [ie one exam at a time] was insufficient to offer assessment to all the doctors who wished to be assessed," he said.

"We expect to assess 10,000 next year and we believe we will be able to meet demand." He said the centre had recruited 450 new examiners already and will advertise for 200 more. Candidates need to be ST2 or above, staff specialty trainee doctors with more than 2 years of experience.

Mr Hankins said demand was due to "word getting out" that jobs were available in the NHS, with even some specialty training places going unfilled. "Access to UK specialist training is very attractive. Our aim is to make assessment available to all who want to be assessed," he said.

Appeal of Working in the NHS

Three doctors from India who passed the test at the previous centre were on hand to tour the new space, and shared their reasons for coming to the UK to work.

Dr Alex Vallakalil said he had been keen to carry out his psychiatric training in the UK. "There's more opportunity for professional development rather than just doing busy shifts. There's a chance to rotate among different sub-specialities. A lot of training opportunities," he said. He noted that he'd had to wait almost 4 months to do his PLAB 2 after finishing PLAB 1, and that a shorter waiting time would be very helpful. He is shortly to begin specialist training in psychiatry.

"I just wanted to do training abroad and what I loved here was more interactive sessions with the patients," said Dr Reshmitha Vijayakumar.

For Dr John Jeba Raj Muthiah Raj, the NHS itself was an attraction: "There's a big difference here with the NHS providing free healthcare for everyone. That makes a big difference in the way you practice as a clinician. Ordering tests with a clinical reason rather than thinking about the cost all the time. You can treat with a more holistic approach."

Nervous Candidates 

The GMC staff and examiners go out of their way to make the candidates feel relaxed, these doctors say.

Dr Vijayakumar says that the "nervousness and tension" of the exam disappeared as soon as it was underway. "I was pretty nervous but once I'd started, it all disappeared and then it's like a day in the hospital. It moves so quickly so by the end of the first scenario all your concentration goes to the next one."

"I was told: 'just be yourself and think it's a busy clinic and I have lots to do'. It's about being yourself and communicating well," says Dr Vallakalil.

The candidates have two rest periods during the exam, during which they can have refreshments – "the best cookies" according to the former candidates – and gather their thoughts. Examiner Sanjoy Bhattacharyya, vice chair of PLAB 2, says some candidates do "dry up and freeze" but that the examiner or actor is provided with prompts to get them talking or help them get back on track. "If the doctor dries up you step in with some questions to get a response," he says.

Preventing Fraud

With all the hard work that goes into PLAB2, from the examiners and the candidates alike, it's vital that the system is not undermined by fraud. Mr Hankins says they have recently invested in facial recognition software to guard against identity fraud.

"We have always taken pictures but this provides more data," he says. "Frauds we have seen have been people pretending to be a registered doctor who they are not."

He said there was "no evidence" that fraud was getting more common, but that now "the technology is there" to guard against it. 

In addition to the new PLAB2 assessment centre, the GMC is making more places available for doctors to take PLAB1, with a new centre in France (the first in mainland Europe), tests held four times a year overseas, and four times a year at five locations in the UK.

Ms Durkin said the additional places will help meet demand among doctors and in the NHS.

"Recruiting enough doctors, with the right skills, is vital for health services in all four UK countries. It is important that we provide a route for those doctors who want to work here to do so."

Doctors who pass both PLAB exams are then free to apply for jobs in the UK. The PLAB 2 qualification is valid for 2 years.

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