The Medical Licensing Assessment and the therapeutic illusion

Teaching primary care theory to promote general practice among medical students

“…Some specialists, by contrast, struggle to see primary care theory as core clinical knowledge of relevance to a Foundation year one doctor. This perception lies in the absence of general practice from Foundation year one posts and, thus, the GMC’s forthcoming Medical Licensing Assessment (Cooper Sornalingam and Heath, 2022). At worst, the outcome can be a perspective among some specialists that general practice is ‘just another placement’ to learn those aspects of general practice that overlap with diagnostic medicine in the hospital.…”

The battle to retain GPs: the importance of undergraduate training in general practice

“…Despite the 2016 Wass report,3 there has been little progress in tackling the low status of general practice in UK medical schools 4. This situation is likely to worsen with the forthcoming national medical licensing assessment (MLA) and anticipation of a league table of medical school performance 5. With its single best answer format and focus on diagnoses, tests, and drugs, the MLA only engages students in the components of general practice that overlap with diagnostic hospital medicine 5.…”

“…This situation is likely to worsen with the forthcoming national medical licensing assessment (MLA) and anticipation of a league table of medical school performance 5. With its single best answer format and focus on diagnoses, tests, and drugs, the MLA only engages students in the components of general practice that overlap with diagnostic hospital medicine 5. It also drives a focus on events (such as clinical presentations or drug side effects) that are relatively uncommon in general practice.…”

“…It also drives a focus on events (such as clinical presentations or drug side effects) that are relatively uncommon in general practice. To fulfil the government’s expectation that 50% of medical students become GPs, expanded undergraduate preparation for the quotidian challenges of the primary care workplace must become a priority 56…”

The elephant in the GP education research room

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The MLA's 'single best answer' model fails to capture the complex and subjective nature of GP clinical decision-making. 3 Assessment drives learning, 2 and the MLA is likely to reshape curricula and student experience to the detriment of general practice. 3 This process is already underway, for example, through final year curriculum reorganisation to prioritise MLA preparation above community generalist placements (in order to promote overall 'school performance' in a future national league table).

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