Championing generalism in educational assessment: the MLA experience

The General Medical Council (GMC) introduced the Medical Licensing Assessment (MLA) to ensure that all doctors seeking registration to practise in the UK meet a common threshold.1 All students across the UK must now sit the same Applied Knowledge Test (AKT). Skills are tested in the Clinical and Professional Skills Assessment (CPSA). This is an OSCE-style exam devised by individual medical schools but subject to GMC approval. The AKT and CPSA are informed by a document listing the topics that will be assessed. This MLA content map (MLA-CM) contains, for instance, an extended list of presentations a newly qualified doctor might encounter. The MLA-CM is highly influential in determining the nature of exit assessments in UK medical education. It embodies not just the content but the values of modern medicine in the UK. Rightly, the GMC is keen to ensure that the MLA-CM is fit for purpose and reflects society’s expectations of newly qualified doctors. To achieve this, the GMC launched a review process for the MLA-CM in 2024. As general practice undergraduate teaching leads in the UK’s Society for Academic Primary Care (SAPC), we coordinated a response to this call. We suggested presentations and conditions missing from the first iteration — for example, domestic violence. We also made a number of pleas for the MLA to embody a generalist perspective. For instance, emphasising the context in which disease states arise, with reference to things like childhood trauma, migration status, poverty, insecure housing, discrimination, and other social determinants of health.2 The GMC recently published the results of its 2024 MLA-CM review and has taken further feedback. In this editorial, we reflect on the latest iteration and explain the vital contribution of medical generalism in assessment frameworks like the MLA.