Role of the AMC, USMLE and PLAB exams for the MBBS students

Overview

For MBBS graduates who wish to establish a global career in the field of medicine the first major milestone is to crack the licensing exams of various countries. Among the most sought after routes are the Australian Medical Council, the United States Medical Licensing Examination and the Professional and Linguistic Assessments Board. These exams not only open the doors to practice in countries like Australia, the USA and the UK. Besides that it also offers a wide range of opportunities in each of the countries. This article will help you understand each and every aspect of the AMC, USMLE and PLAB.

Introduction to AMC, USMLE and PLAB

The AMC, USMLE and PLAB licensing examinations are intended to guarantee that international medical graduates meet the standards necessary to practice safely in a foreign healthcare system.

AMC: The Australian Medical Council exam is a pathway to practice in Australia
USMLE: It is a pathway for medical licensure in the USA
PLAB: It is a pathway to practice in the UK

These exams are responsible for assessing: 

• Clinical knowledge
• Patient management skills
• Communication 
• Decision making 

Selecting the applicable exam is based on: 

• Career objectives 
• Budget
• Preferred country
• Academic strength

What is the Australian Medical Council?

Some medical graduates tend to work in Australia after their graduation. There is no doubt that the Australian Medical Council assesses international medical graduates. You will get two main stages in the AMC exam. It includes the MCQ and clinical exam. 

AMC MCQ Exam

The AMC clinical exam consists of MCQs. It is a computer based test with 150 multiple choice questions. This is the structure of the MCQ exam: 

Computer based test

The AMC MCQ test is computer-based. It means that the test is conducted electronically at the test centres. This contrasts with the traditional pen and paper test. The students are required to respond to all the questions on the computer screen. This type of test enables standardisation across centres and the timely processing of results. It also requires the students to be familiar with the computer and the test environment.

150 questions 

The test is composed of 150 multiple choice questions. Moreover, they are designed in a way that they test the candidate’s ability to apply medical knowledge in a given situation. The questions are not simple but are designed in a way that you have to analyse the situation given and choose the most appropriate diagnosis or action. There is only one correct answer for every question but there are distractors as well.

Includes clinical subjects 

The AMC MCQ exam focuses primarily on clinical subjects. This is how it emphasises on real world practice as opposed to theoretical knowledge. The main areas of study include internal medicine, surgery, pediatrics, obstetrics and gynecology, psychiatry and general practice. The questions are also case based. It indicates that you are given a case and asked questions similar to what you might encounter in a hospital in Australia. This is a good approach as it ensures that in addition to being knowledgeable you are also able to apply what you know.

AMC Clinical Exam 

Besides the MCQ there is also the AMC clinical exam. It consists of the objective structured clinical examination, real life patient scenarios and communication testing. This is the structure of the AMC clinical exam: 

Objective Structured Clinical Examination

The Objective Structured Clinical Examination is an assessment technique that is hands on in nature. Moreover, it is used in the Australian Medical Council clinical examination to test the real life medical knowledge of a candidate. This is in contrast to written tests as in the OSCE test candidates are required to rotate through a series of stations based on a specific test objective. The candidates are then assessed based on specific marking criteria by the examiners. This ensures that all candidates are given a fair assessment as they are required to go through the same test environment. This assessment technique is widely used across the globe as it tests not only the knowledge but also the practical ability of a doctor.

Real life patient scenarios

Another important aspect of the OSCE is that it incorporates real life patient scenarios. This means that for every test station the candidates may be required to deal with some real life medical conditions. These are likely to be representative of the kinds of cases that a doctor may encounter in his or her daily work in Australia. This means that a candidate may be required to take a medical history, explain a medical diagnosis or even respond to an emergency situation.

Tests clinical skills and communication 

The OSCE also assesses clinical skills and communication. They are equally important in the safe and effective practice of medicine. Communication skills include how well a candidate listens to patients, how well they present a patient’s medical condition in simple language and how well they empathise with patients and establish trust with them. On the other hand, clinical skills include a candidate’s physical examination skills, clinical reasoning, diagnosis and treatment planning. The examiners will not only observe what a candidate does but also how they do it, including whether they remain professional and ensure patient comfort throughout the process.

What is the United States Medical Licensing Examination?

When we talk about the most reputable medical licensing exam, the United States Medical Licensing Examination stands out. 

Steps of USMLE 

These three steps are involved in the United States Medical Licensing Examination: 

Step 1

• Basic sciences
• Anatomy, physiology, biochemistry

Step 2 

• Clinical knowledge
• Diagnosis and management

Step 3

• Final licensing step
• Taken during or after residency

Residency requirement 

Before practising medicine in the USA there are a few residency requirements. Among AMC, USMLE and PLAB residency requirements the USMLE takes centre stage. 

Clear USMLE

To practice medicine in the United States an international medical graduate must first pass the United States Medical Licensing Examination. It is a three step test that measures medical knowledge and skills. A candidate’s ability to pass these steps means they are qualified to begin practising medicine.

Match into residency with the National Resident Matching Program

Once the applicants have completed the required steps, they need to match with a residency program. It is known as the National Resident Matching Program. This is a system in which applicants and hospitals are matched. A computer then matches applicants to residency programs. Matching into a residency program is very important, as it is required to become a licensed doctor in the USA.

What is the Professional and Linguistic Assessments Board?

The General Medical Council conducts the Professional and Linguistic Assessments Board. It allows access to international doctors: 

PLAB structure 

There are two structures of the PLAB exam. It consists of PLAB 1 and 2. In this section, we will explain the two structures in detail. 

PLAB 1

Part 1 is a multiple choice question test. This test assesses the candidate’s knowledge of applying it in medicine. This is a single best answer MCQ where each question presents a clinical situation and you are required to choose the most suitable diagnosis, investigation or management. This test is more focused on clinical problem solving than memory. This includes topics such as medicine, surgery, paediatrics, obstetrics and gynaecology and psychiatry. The questions are also relevant to the standards expected of a doctor entering the UK healthcare system. This is a safe and effective way of handling patients. The best part is that it is conducted in multiple countries including India. 

PLAB 2

The second part of the Professional and Linguistic Assessments Board is known as the PLAB 2. It is a clinical test conducted through an objective structured clinical examination. This test is different from the previous one as it focuses on evaluating the candidate's capability to interact with patients and manage situations in real life. This is achieved through a series of stations where candidates are required to perform tasks such as taking a patient's history, performing a physical examination, communicating with patients and making decisions. The test is not only focused on the knowledge of the candidates but also on their professionalism, empathy and communication skills. Undoubtedly, these qualities are required for a doctor. The United Kingdom conducts this test. 

Comparison between AMC, USMLE and PLAB

In this section, we will compare between AMC, USMLE and PLAB. This comparison gives you an idea that these tests are different: 

Eligibility Criteria for AMC, USMLE and PLAB

Academic requirements, internship and English proficiency are the eligibility criteria for the AMC, USMLE and PLAB exams. These criteria need to be considered: 

Academic requirements

For the purpose of taking licensing exams such as AMC, USMLE and PLAB the individual must possess an MBBS degree from a recognised medical university. The MBBS degree should meet global standards for medical education. This means that the individual has been provided with proper knowledge and training. Another important factor is that the medical college should be included in the World Directory of Medical Schools. This is a database of all medical institutions worldwide. Being included in the database means that your qualification is acceptable for the subsequent licensing processes. Without this recognition the individual may not be allowed to take the licensing exams in the USA, UK and Australia.

Internship 

The internship is a crucial component of medical education and plays a significant role in eligibility. For pathways like AMC, USMLE and PLAB completing a one year compulsory internship is generally mandatory. The reason is that it demonstrates hands on clinical experience in patient care. This includes exposure to different departments such as medicine, surgery, pediatrics and obstetrics. In contrast, for the United States Medical Licensing Examination internship is not strictly required at the time of appearing for the exam. However it is highly recommended. This is because clinical experience strengthens your profile when applying for residency programs and improves your chances of selection.

English proficiency

Since doctors need to communicate effectively with patients as well as the healthcare team, English language proficiency is an important requirement. It is especially for countries like the UK and Australia. For the AMC as well as the PLAB route candidates need to pass tests like IELTS or OET exams. For the PLAB route this is a mandatory requirement for candidates before they appear in the exam. They are expected to meet the communication standards set by the General Medical Council. For the AMC route English language proficiency is a requirement during the registration process as well. When it is about the USMLE route there are no English tests. Certainly, the communication skills are indirectly tested during the clinical practice in the US itself.

Exam pattern and syllabus comparison

You need to be aware of the exam pattern and syllabus comparison of the AMC, USMLE and PLAB. This is a comparison below: 

AMC: Clinical based questions & real life practice

The Australian Medical Council exam is intended to test the candidate’s capacity to perform well in the actual clinical environment in Australia. The questions are mostly clinical based. It means that the questions are based on cases rather than theoretical ideas. The students are given the opportunity to make decisions such as diagnosis and treatment based on the information given. This way students are not just expected to remember facts but also use the practice.

Furthermore, there is a strong emphasis in AMC on real life medical practices. This means that the exam is representative of the types of cases that doctors frequently come across in Australia’s medical facilities. It also includes those in general practices. It also tests a patient centered approach as well as reasoning and decision making skills. This means that a candidate needs to be sufficiently prepared to think like a real-life doctor taking into account a balanced approach between knowledge and practical situations.

USMLE: Deep conceptual understanding & theory and clinical integration

The United States Medical Licensing Examination is renowned for its stringent and extensive testing system. It requires a conceptual understanding of the medical sciences. USMLE is different from other examinations that focus solely on clinical scenarios. USMLE examines the basic principles of medicine such as physiology, pathology, pharmacology and other subjects like biochemistry. A medical aspirant needs to be aware of the basic principles behind the answers.

Another feature that clearly defines USMLE is its emphasis on integrating theory and clinical knowledge. Most questions posed by USMLE integrate basic science questions with case studies. Thus, it requires candidates to have a strong foundation of basic science knowledge which is essential for a successful career in medicine especially in America. For instance, a question may require a candidate to have a basic understanding of a disease process, then apply that knowledge to solve a case.

PLAB: Practical, scenario based questions & UK guidelines

The main focus area for the Professional and Linguistic Assessments Board is to assess whether a candidate is prepared to become a junior doctor in the United Kingdom. Undoubtedly, the questions in this exam are scenario based. These questions require a candidate to select the most appropriate course of action from a list of clinical situations that are presented to them. The questions are simple and based on real life situations that are commonly encountered in the healthcare system in the United Kingdom.

One of the important aspects of the PLAB exam is the focus on UK clinical guidelines and protocols especially those used in the NHS as regulated by the General Medical Council. The doctors are expected to make clinical decisions based on the common practices used in the UK including patient safety, ethical issues, communication and so on. This helps ensure that international doctors are fully prepared to fit in with the healthcare system in the UK in a smooth manner.

Best countries for MBBS

When it comes to AMC, USMLE, and PLAB, three countries are preferred for an MBBS program. For AMC Australia it is the preferred country, for USMLE it is the United States and for PLAB it is the United Kingdom. 

Australia 

Australia is one of the most preferred destinations for international medical graduates. This is because it provides a perfect blend of a healthy lifestyle and a good medical infrastructure. A doctor in Australia enjoys a good work-life balance. The working hours of a doctor in Australia are controlled and the infrastructure is good. In addition, the standard of living is very high. This is one of the major advantages of the AMC exam. The major advantage of the AMC exam is the huge demand for doctors. In particular there is a shortage of medical practitioners in rural and regional areas. This means that the chances of getting a job in Australia for a qualified candidate who has cleared the Australian Medical Council exams are relatively higher. Moreover the standard of living in Australia is very high.

United States

The United States is considered the best country to specialize training in medicine. Through the United States Medical Licensing Examination a medical graduate can access world class training programs that provide cutting-edge training in medicine. Another advantage is that the United States is considered to have many specialties. Thus, it provides many career options for physicians to specialise in their chosen area and it creates a prestigious career. Another advantage is that the salary is at a peak especially after completing residency training and gaining experience. However one of the main challenges is that the process is highly competitive thus taking time, effort and money. Despite these challenges the benefits of career growth, research and financial stability make the United States one of the best destinations for ambitious graduates.

United Kingdom

The United Kingdom is also a popular choice for MBBS graduates who are seeking a faster and easier route for working abroad. Without any doubt, the Professional and Linguistic Assessments Board route is popular for its easier immigration process compared to the other countries. This route does not require a mandatory residency match as in the case of the USA. Once the candidates are cleared in the PLAB and register with the General Medical Council they can directly apply for jobs in the NHS. The UK also offers a training route for doctors. In this route doctors can gradually move up the levels of training while gaining practical experience. This route is well structured and offers a bright career for specialization. The UK also offers a multicultural working environment and exposure to a variety of cases for doctors.

Conclusion

One of the most important decisions for MBBS graduates aspiring to work abroad is choosing between AMC, USMLE and PLAB. Choose USMLE for high paying jobs and specialisation in top tier fields. Opt for AMC in case of a balanced career in Australia. Choose PLAB for a faster and cost effective route to the UK. Each option has its pros and cons. It is important to assess your financial requirements, career aspirations and academic capabilities before making a decision.