Variations in medical school graduating examinations in the United Kingdom: Are clinical competence standards comparable?*

Background: While all graduates from medical schools in the UK are granted the same licence to practise by the medical professional regulatory body, the General Medical Council, individuals institution set their own graduating examination systems. Previous studies have suggested that the equivalence of passing standards across different medical schools cannot be guaranteed. Aims: To explore and formally document the graduating examinations being used in the UK Medical Schools and to evaluate whether it is possible to make plausible comparisons in relation to the standard of clinical competence of graduates. Methods: A questionnaire survey of all the UK medical schools was conducted, asking for details of graduating examination systems, including the format and content of tests, testing time and standard setting procedures. Results: Graduating assessment systems vary widely across institutions in the UK, in terms of format, length, content and standard setting procedures. Conclusions: We question whether is it possible to make plausible comparisons in relation to the equivalence of standards of graduates from the different UK medical schools, as current quality assurance systems do not allow for formal quantitative comparisons of the clinical competence of graduates from different schools. We suggest that national qualifying level examinations should be considered in the UK.