Teaching standards seem to vary wildly in UK medical education. The call is now for a national qualifying examination for all graduates.
Tests taken by UK doctors show enormous variation in performance depending on which medical school they attended, according to new research.
Medical graduates from Oxbridge and Newcastle universities performed better than average while those from Liverpool, Dundee, Belfast and Aberdeen universities did least well in an exam for aspiring specialist physicians in the UK.
The General Medical Council, which is responsible for setting standards, has mooted introducing a national medical licensing exam, such as exists in the US, but medical schools have opposed the move on the grounds that there was no evidence it was needed.
The latest research, led by Prof Chris McManus at University College London, shows clear differences in the performance of 5,827 UK medical graduates from 19 different British universities, reports the Guardian newspaper.
Researchers assessed the performance of UK medical graduates from 19 British universities in the Membership of the Royal Colleges of Physicians (MRCP(UK)) exam. Most (83%) Oxbridge graduates passed the first part at their initial attempt, as did 67% from Newcastle, compared with 32% and 38% of those from Liverpool and Dundee.
The study also found that men were better than women at the multiple-choice part of the exam but women outperformed men in the clinical stages.
The differences in performance are in part explained by the qualifications graduates held before going to medical school, but the research suggests that differences between the teaching focus, content and approaches of medical schools play a role.
The findings echo those in the most recent analysis of the postgraduate exam for GPs (MRCGP). Between 2003 and 2006, just 15% of graduates from Nottingham, Newcastle and Oxford failed to pass the exam in one go. The fail rate for Dundee, Manchester, Liverpool and three of the London schools (Queen Mary, St George's, King's College) was over twice this. The study also found that failure rates are much higher for foreign graduates (67%) than for graduates from the UK (27%).
McManus said: "Our study provides a strong argument for introducing [a licensing exam], as we have shown that graduates from different medical schools perform markedly differently in terms of their knowledge, clinical and communication skills.
"Although the MRCP(UK) is a widely regarded exam that is carefully designed to assess a wide range of knowledge and skills required by a physician, it is possible that some medical schools teach other important skills that this examination does not assess."
He said there was a real need for routine analysis of UK medical graduates' performance both in postgraduate exams and in a national licensing exam.
A spokeswoman for the GMC said medical schools should design curricula and assessment schemes following guidance set out in "Tomorrow's Doctors".
"We recognise the need to ensure that medical education meets the needs of a changing society, and we are working with the government and key interest groups to confirm that it continues to be provided in an effective and relevant way."
She said a national exam was one of a range of possible options for ensuring consistency of education.
The Medical Schools Council is looking at whether a national assessment is needed to report over the next six months.
Executive director, Katie Petty-Saphon, said: "Medical schools cherish the differences in approach that arrive at a similar end product. External examiners ensure consistency of qualifications and we have confidence in UK graduates."