Cognitive interview study of medical licensing knowledge test published in BMJ Open

A team from the University of Lincoln and the Royal College of General Practitioners, with lead author Dr Julie Pattinson and corresponding author, Prof Niro Siriwardena, have published the first cognitive interview study, exploring reasons for differences in performance between UK trained doctors and doctors trained overseas in a medical licensing exam.


The study, ‘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’, used ‘think aloud’ interviews, which were conducted by Dr Pattinson to elicit the thought processes of doctors during their general practice training while trying to answer knowledge test questions from the licensing assessment. The interviews were also used to compare doctors who had undertaken their undergraduate medical training in the UK with international medical graduates who had trained overseas to understand why there were differences in performance between the two groups.

The interviews identified three areas which explained difficulties for all groups and a fourth, cultural barriers, which were a particular problem for overseas trained doctors. Interviewees reported difficulties recalling information and responding to questions just using theoretical learning compared with actual clinical experience whereas rote learning, which seemed more commonly used abroad helped some IMGs recall rare disease patterns. Interviewees reported greater difficulty answering questions about topics not recently studied, less frequently encountered or perceived as less relevant. Some doctors were over optimistic about their performance on particularly questions despite getting the answer wrong. The cultural barriers for international medical graduates included differences in undergraduate experience, lack of familiarity with UK guidelines and language barriers.

The study findings suggested that most difficulties encountered during the knowledge test could be addressed through training, with additional help for international medical graduates to address differences in educational experience, exam content or language difficulties.

Prof Niro Siriwardena

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