Optimising the transition from selection to licensing in general practice

Problem

The selection process for entry to speciality training for general practice in the UK was changed in 2016 to offer access to a direct pathway (DP) for doctors scoring above an agreed threshold in the computer-marked Multi-Specialty Recruitment Assessment (MSRA). The Selection Centre (SC) for those scoring under this threshold was discontinued due to COVID-19. We aimed to evaluate the relationship between performance at selection and outcomes of general practice (GP) training at licensing, to determine the threshold score at MSRA for optimising performance at licensing, and to evaluate the value of the SC.

Approach

We used a longitudinal design linking selection, licensing and demographic data from UK doctors entering GP specialty training in 2016. MSRA scores were divided into 12 score bands and SC scores into seven score bands to better identify specific MSRA or SC scores that correspond to better or worse GP training outcomes. Multivariable logistic regression models were used to establish the predictive validity of the MSRA scores and score bands for passing or failing the Membership of the Royal College of General Practitioners (MRCGP) licensing assessments including the Applied Knowledge Test (AKT), Clinical Skills Assessment (CSA) or Recorded Consultation Assessment (RCA), Workplace Based Assessment - Annual Review of Competence Progression (WPBA-ARCP), and performance overall. The model adjusted for gender, ethnicity, country of qualification, and declared disability. Receiver Operating Characteristic (ROC) curves of MSRA scores against performance outcomes were constructed to determine the optimal MSRA threshold scores for achieving licensing.

Findings

We included 3338 doctors who entered specialty training for general practice in 2016 of different sex (female 63.81% vs male 36.19%), ethnicity (White British 53.95%, minority ethnic 43.04% or mixed 3.01%), country of qualification (UK 76.76%, non-UK 23.24%), and declared disability (disability declared 11.98%, no disability declared 88.02%).

MSRA scores or score bands were predictive for all GP training outcomes (AKT, CSA, RCA, and WPBA-ARCP). Lower SC score bands corresponded to poorer GP training outcomes but adding SC scores did not change the predictive validity of the MSRA, and therefore the SC did not add further information to MSRA scores. An MSRA threshold of 500 (or, more precisely, 497) was ideal for correctly identifying pass/fail rates on the AKT, RCA, and CSA and only standard outcomes on WPBA-ARCP. Fifty percent of candidates in the lowest two MSRA Bands (i.e., scores below 420) had at least one nonstandard outcome.

Consequences

The optimal MSRA threshold score for achieving licensing was around 500 in this large cohort. The Selection Centre added little to the predictive validity of the MSRA. Doctors admitted to GP speciality training who score below this threshold may need additional support during training maximise their chances of achieving licensing.