PLAB & MRCP Training in United Kingdom

Membership of Royal College of Physicians (MRCP) London

Membership of the Royal Colleges of Physicians of the United Kingdom (MRCPUK)) is a postgraduate medical diploma in the United Kingdom (UK). The examinations are run by the Federation of the Medical Royal Colleges – the Royal College of Physicians of London, the Royal College of Physicians of Edinburgh, and the Royal College of Physicians and Surgeons of Glasgow. The three Royal Colleges of Physicians share this common three part assessment in general medicine which consists of two written parts and one clinical examination. Examinations are held throughout the UK and in overseas centers.

Holders of the MRCP (UK) can subscribe as "collegiate members" to any or all of the three UK Royal Colleges of Physicians. Thus the MRCP (UK) qualification has replaced the former MRCP (London), MRCP (E), and MRCP (G) qualifications.

Aim of Exam
The exam incorporates both examination of the candidate's knowledge of basic medical sciences as well as testing the clinical skills required for the diagnosis and management of disease. Changes to the exam in recent years have put more emphasis on communication skills and professionalism. Obtaining the "MRCP (UK)" is a prerequisite to anyone wishing to go on to a specialist training post as a Physician in the United Kingdom. Various companies, including the Royal Colleges themselves, have developed preparatory courses that focus on the nature of the questions and the required background knowledge.

In partnership with the relevant specialist societies, the three UK Royal Colleges have set up the MRCP Specialist Examinations Unit responsible for the organization of new knowledge based assessments. The ultimate objective is to ensure that NHS consultants have demonstrated their acquisition of sufficient knowledge in their chosen specialty to practice safely and competently. This will bring the assessment of physicians in training in the UK into line with those training in North America, where most specialist trainees sit a specialist examination as a further test of excellence, usually after having acquired certification in Internal Medicine.

Medical Training

Foundation Years
The Foundation Programme is a two-year training programme for doctors who have just graduated from medical school.

It gives doctors in training experience in a range of different areas of medicine.

Doctors on the Foundation Programme are responsible for caring for patients under the supervision of more experienced doctors and other healthcare professionals.

After finishing the Foundation Programme, doctors choose an area of medicine to focus their training on. This may be a specialty or it may be general practice.

For the first year of the Foundation Programme (F1), doctors are provisionally registered with the GMC. During this year they must show that they have met the outcomes in Outcomes for provisionally registered doctors before they are eligible to apply for full registration.

In the second year of the Foundation Programme (F2) doctors are fully registered with the GMC. They still work under supervision but start to take on more responsibility for patient care.

CMT-Core Medical Training
The programme is overseen by the Joint Royal Colleges Postgraduate Training Board, which represents the three medical Royal Colleges in the UK: the Royal College of Physicians of London, the Royal College of Physicians of Edinburgh and the Royal College of Physicians and Surgeons of Glasgow.

Annual recruitment takes place centrally through a website-based application, followed by interviews held by regional Local Education and Training Boards.

Core medical training is one of the most popular medical specialties with over 2700 applicants applying for just over 1500 jobs each year. The ACCS (Acute Medicine) pathway also uses the core medical interview to recruit to ACCS.

CMT rotations characteristically comprise 4- or 6-month placements in various medical specialties. Part of the programme should include posts where the trainee is involved in the "acute medical take" (assessing patients referred for acute admission to hospital) and to become competent in acute scenarios and procedures.

CMT doctors are CT1 or CT2 (first or second year, respectively). At three points in the programme they undergo a progress assessment called Annual Review of Competence Progression (ARCP). CMT doctors are expected to complete the Membership of the Royal College of Physicians (MRCP) exam, without which it is not possible to enter specialist training.

Technically, since Modernising Medical Careers, CMT doctors are called specialty registrars, although the term is usually reserved for those who have completed MRCP and commenced subspecialty training.

Curriculum and assessment information for Core Medical Training.

Specialty Training
In the UK medical system, a specialist is someone who has the necessary experience and qualifications to be placed on the GMC's Specialist Register. Only persons on the Specialist Register can be appointed consultants in the National Health Service (NHS). Training to become a General Practitioner will also involve a Specialty Registrar training scheme and completion will lead to eligibility for entry on the General Practice Register.

Doctors can enter this training grade after completing their foundation training, but need to go through a competitive process of entry into specialty training schemes. Completing the training scheme will lead to the award of a Certificate of Completion of Training (CCT), subject to satisfactory in-training assessment and progress; this is a necessary pre-requisite for entry onto the Specialist Register or GP Register.

Specialty Training programmes varies in length and are tailored to the needs of the specialty. The curricula used for the different specialty training schemes are set by the relevant medical royal college. Under the old system, before applying for the old Registrar posts, applicants were required to have sat and passed part, or all, of a medical royal college's membership examinations while still a Senior House Officer. Under the new system Foundation doctors do not need to sit these exams as they play no part in the selection process and are discouraged from doing so. It is, however, still common practice to begin to take these exams during the second year of the foundation programme and is recommended by experts outside MMC. The appropriate royal college exams will now be taken during the first year or two of the Specialty Registrar training scheme.

CCT-Certificate of Completion of Training
It is a legal requirement that a doctor practicing as a substantive, fixed term or honorary consultant in the NHS holds specialist registration and that a doctor practicing as a GP in the UK holds GP registration. A CCT confirms that a doctor has completed an approved training programme in the UK and is eligible for entry onto the GP Register or the Specialist Register.

The GMC have approved and quality assured the training programmes that eligible CCT applicants have completed. This means an application for entry onto the Specialist or GP Register with a CCT is less complicated and quicker than other Specialist or GP Registration applications.

MRCP Exams
The MRCP exam has three parts: MRCP Part 1 (written paper); MRCP Part 2 (written paper); and MRCP Part 2 Clinical Examination (PACES).

The MRCP part 1 examination consists of multiple choice questions in the best of five format.

The MRCP part 2 examination consists of multiple choice questions in the best of five format.

The MRCP PACES examination consists of a carousel with 5 stations.

• Station 1. Tests the candidate's ability to examine the respiratory system and abdomen.
• Station 2. Tests the candidate's history taking ability.
• Station 3. Tests the candidate's ability to examine the cardiovascular system and perform a neurological examination.
• Station 4. Tests the candidate's communication skills and the ability to deal with issues of medical ethics.
• Station 5. Comprises two 8-minute "integrated clinical assessments" requiring the candidate to take a focused history and examination, formulate a differential diagnosis and management plan, and communicate the plan to the patient.

PACES - Countries hosting
The MRCP PACES examination is held not only in the United Kingdom, but also in many other parts of the world. Hosting sites include Brunei, Dubai, Al Ain, Egypt, Kuwait, Oman, Qatar, India, Singapore, Malaysia, Malta, Hong Kong, Myanmar, Sri Lanka, and Sudan. Examination fees at centers outside the UK are significantly higher than at UK centers. In Singapore, the MRCP (UK) and MMed are often taken together. In Hong Kong, MRCP (UK) is taken with MHKCP intermediate examination.

Examination cost is £1495 from start to finish if all parts are taken in the UK and £2390 if are taken overseas – assuming each examination is passed in a single attempt without attending any courses. Candidates may elect to participate in any of a number of training courses, online revision websites or use mobile applications as revision aids to improve their chances of passing.

International Medical Graduates

PLAB Route
The Professional and Linguistic Assessments Board (PLAB) test provides the main route for International Medical Graduates (IMGs) to demonstrate that they have the necessary skills and knowledge to practice medicine in the United Kingdom (UK). PLAB is a two part assessment that overseas doctors (or international medical graduates), from outside the European Economic Area and Switzerland, usually need to pass before they can legally practice medicine in the UK. It is conducted by the General Medical Council of the United Kingdom. The test is designed to assess the depth of knowledge and level of medical and communication skills possessed by the international medical graduates. The PLAB blueprint sets out what candidates are expected to demonstrate in the test and beyond.

PLAB Part 1 : Consists of a multiple choice format examination paper with 200 SBA's (Two Hundred Single Best Answer questions) lasting 3 hours, This part is conducted in a number of countries including Bangladesh, Egypt, India, Pakistan, Nigeria and Sri Lanka.

PLAB Part 2: Consists of an objective structured clinical examination (OSCE). This Part is available only in the city of Manchester, United Kingdom. It consists of 18 clinical stations. All the stations are eight minutes long, plus two minutes reading time. The standard of both parts of the PLAB exam is set at the level of competence of a doctor at the start of Foundation Year 2 (F2) in the Foundation Programme.

MTI -Medical Training Initiative

The Royal College of Physicians' MTI scheme offers sponsorship for GMC registration and Tier 5 visa support to enable international medical graduates (IMGs) to access short-term training opportunities in the UK. The scheme aims to facilitate access to core medical or advanced specialty training and service experience for overseas doctors to improve the management and treatment of patients around the world.

Qualifications and experience of the applicant
You must fulfill all of the following criteria:
• You must hold a primary medical qualification recognized by the GMC.
• You need to have a postgraduate qualification (MRCP (UK) part 1, MD or other higher degree in medicine or a medical subspecialty.)
• You must have completed at least 3 years of full-time postgraduate training (including 1 year's internship and at least 1 year in the specialty in which you intend to train while in the UK).
• You must have been in clinical practice for 3 out of the last 5 years including the 12 months prior to GMC registration being granted. There should be no gaps in employment. Please note that the GMC does not consider clinical observer ships as clinical practice. It is important that you remain in clinical practice during the application process.
• You must possess the skills, competencies and understanding of medicine at least equivalent to a UK graduate at the end of their CMT.

The RCP cannot sponsor doctors who have failed the Professional and Linguistic Assessments Board (PLAB)

You need to have obtained a minimum overall score of 7.5 in the International English Language Testing System (IELTS) examination, with minimum scores of 7.0 in all categories. The scores should be obtained in one sitting. The test is valid for 2 years.

Doctor of Medicine without PLAB (Clinical MD)

(Three Years Program)

Entry Requirements
International Applicants
• An MBBS or equivalent degree from an internationally recognized medical school.
• Two years post MBBS experience including one year of internship at a hospital and must supply their Certificate of Completion.
• Should not be any unexplained gap in their post MBBS career.
• Should not have appeared and failed to pass the PLAB examination.
• IELTS 1-score overall-6.5, with a minimum of 5.5 in each section.& overall-7.5 and 7.0 in each section
• Completed their undergraduate training and be fully registered with the Medical Council in their respective countries.

About the Institution
• 180 year Old Government University
• One of the oldest Higher Education Institution in United Kingdom
• World ranking better than AIIMS, Delhi
• Training association with NHS Hospital
• Excellent Infrastructure and technologically well equipped

Training Pathway

Traditional route is the route, we all are very well aware of. It requires you to clear PLAB to join any PG program or specialty training in UK. In other words we can say that after clearing PLAB 1 and PLAB 2, you are entitled for GMC Registration. After GMC registration and required experience, you are required to take MRCP 1 to join Core Medical Training (CT 1 & CT 2). After two years of training one is required to clear MRCP 2 and MRCP Paces. It awards MRCP Diploma enabling you to take job in UK as a GP.

Clinical MD in internal Medicine is a new programme developed by the University in conjunction with NHS Foundation Trust, primarily aimed at the International Medical Graduates. In order to successfully complete this Clinical MD program, candidates are expected to have GMC registration supported by the Royal College of Physicians' (RCP) Medical Training Initiative programme. Hands on clinical training will be provided by senior clinicians and medical educators.

As discussed earlier (MTI) we have discussed about the sponsorship by Royal College of Physicians London (MRCP) subject to fulfillment of conditions laid down by the sponsoring body enabling one to take Clinical MD or Specialty Training in UK without clearing PLAB 1 & PLAB 2.

The curriculum is linked to the e-Portfolio as it defines standards required for good medical practice laid out by the General Medical Council and a successful formal assessment at the end of each year placement. In order to obtain the degree candidates need to pass the Exit Exam along with successful completion of all the other modules and the MD dissertation. In conjunction with the Medical Training Initiative Programme by the Royal College of Physician, London, it was agreed that the NHS e-portfolios and the national Core Medical Training curriculum will be used to train and assess the trainees for the Clinical MD programme. Therefore, this curriculum was based in line with the RCP CMT curriculum under the direction of the Joint Royal Colleges of Physicians Training Board (JRCPTB).

In brief, student directly joins CT1 & CT2 training (No need to take PLAB 1 & PLAB 2 ) and during two year training student is encouraged to take MRCP {UK}. Student is eligible to work in the concerned specialty and can also take Specialist Training (ST3 onwards).