• Paul A Tiffin, Jan Illing, Adetayo S Kasim, and John C McLachlan.
• School for Medicine, Pharmacy and Health, Wolfson Research Institute for Health and Wellbeing, Durham University Queen's Campus, Stockton-on-Tees TS17 6BH, UK.
• BMJ. 2014 Apr 17; 348: g2622.

ObjectiveTo determine whether use of the Professional and Linguistic Assessments Board (PLAB) examination system used to grant registration for international medical graduates results in equivalent postgraduate medical performance, as evaluated at Annual Review of Competence Progression (ARCP), between UK based doctors who qualified overseas and those who obtained their primary medical qualification from UK universities.DesignObservational study linking ARCP outcome data from the UK deaneries with PLAB test performance and demographic data held by the UK General Medical Council (GMC).SettingDoctors in postgraduate training for a medical specialty or general practice in the UK and doctors obtaining GMC registration via the PLAB system.Participants53,436 UK based trainee doctors with at least one competency related ARCP outcome reported during the study period, of whom 42,017 were UK medical graduates and 11,419 were international medical graduates who were registered following a pass from the PLAB route.Main Outcome MeasureProbability of obtaining a poorer versus a more satisfactory category of outcome at ARCP following successful registration as a doctor in the UK.ResultsInternational medical graduates were more likely to obtain a less satisfactory outcome at ARCP compared with UK graduates. This finding persisted even after adjustment for the potential influence of sex, age, years of UK based practice, and ethnicity and exclusion of outcomes associated with postgraduate examination failure (odds ratio 1.63, 95% confidence interval 1.30 to 2.06). However, international medical graduates who scored in the highest twelfth at part 1 of the PLAB (at least 32 points above the pass mark) had ARCP outcomes that did not differ significantly from those of UK graduates.ConclusionsThese findings suggest that the PLAB test used for registration of international medical graduates is not generally equivalent to the requirements for UK graduates. The differences in postgraduate performance, as captured at ARCP, following the two routes to registration might be levelled out by raising the standards of English language competency required as well as the pass marks for the two parts of the PLAB test. An alternative might be to introduce a different testing system.

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