Exploring reasons for differences in performance between UK and international medical graduates in the Membership of the Royal College of General Practitioners Applied Knowledge Test: a cognitive interview study

What is it about?

This study is the first to explore how trainee doctors perform in the Membership of the Royal College of General Practitioners Applied Knowledge Test using ‘think aloud’ interviews. We asked doctors to explain their thought processes while answering questions to better understand why International Medical Graduates perform less well than UK graduates in the national licensing exam for general practice. This is an important and ongoing problem for doctors in training and training programmes. We interviewed 21 GP trainees including 13 International Medical Graduates and 8 UK trained doctors from the East Midlands region of the UK. We found four key issues. Interviewees reported difficulties recalling information and responding to questions from theoretical learning compared to clinical exposure. In some cases rote learning helped (particularly for IMGs) recall rare disease patterns. Interviewees reported greater difficulty answering questions on topics which they had not recently studied or encountered or perceived as less relevant. Some interviewees were over optimistic about their test performance despite answering incorrectly. International Medical Graduates had different undergraduate experiences, were less familiar with UK guidelines, and experienced language barriers which made it more difficult to answer some questions. The difficulties interviewees experienced when answering these questions, including additional difficulties faced by International Medical Graduates due to different educational experiences, lack of familiarity with the NHS and language barriers, may be addressed through training.

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