International medical graduates pass UK postgraduate medical exams at lower rates than UK graduates, and the gap is large, persistent, and well documented. This page sets out the data plainly, summarises what the research says about the causes, and focuses on what actually helps, because the evidence points to structural factors and targeted support rather than to any difference in ability or motivation. It is written to inform, not to alarm.
Key takeaways
- In 2022/23 the MRCGP AKT pass rate was 85% for UK graduates and 56% for IMGs, a 29-point gap.
- The gap has persisted across years and appears across UK postgraduate exams, not just the MRCGP.
- Research links attainment to the language of the primary qualification and to earlier assessment scores.
- The causes are understood to be structural, not a matter of ability or motivation.
- What helps is early identification, targeted support, exam-format familiarity, and structured feedback.
The data
The most recent detailed figures come from the MRCGP. In 2022/23, the Applied Knowledge Test pass rate was 85% for UK graduates and 56% for international medical graduates, a gap of 29 percentage points, and the consultation assessment showed a similar pattern, with reported pass rates of 94% for UK graduates and 57% for IMGs. This is not a one-year anomaly: the AKT gap has persisted across multiple academic years without narrowing significantly. Similar differential attainment patterns are seen across other UK postgraduate examinations. IMGs are not a marginal group in this context; they comprise more than half of GP registrars, trained across dozens of different countries.
What the research says about the causes
A 2025 observational study in the British Journal of General Practice examined all candidates who sat the MRCGP exams between October 2013 and July 2021, a cohort of 28,020, and found that the language of the primary medical qualification was associated with attainment: IMGs who trained in countries where English is not the first language had significantly lower odds of passing and lower scores across all components. The study also found significant positive correlations between candidates' earlier MSRA, IELTS, and PLAB scores and their later MRCGP performance. The authors are careful to note that the reasons are not fully understood, but the pattern points to structural factors: familiarity with UK guidelines and the NHS context in which the exams are set, familiarity with the exam format, and the additional cognitive load of working and being assessed in a second language. These are features of training background and context, not of ability or motivation.
What the system is doing
There is active work on this. The awarding bodies and deaneries run induction and support programmes aimed at IMGs entering UK training, the RCGP has undertaken reviews of the fairness of its assessments, and structural changes have been made partly with inclusivity in mind, including the move in October 2025 to a shorter AKT of 160 questions in 160 minutes, which was framed around reducing assessment burden and supporting candidates who need reasonable adjustments. The GMC monitors differential attainment across training through its data explorer. Progress is monitored and debated, and the gap has not yet closed, so this remains an area of ongoing attention rather than a solved problem.
What the evidence says helps individuals
For an individual candidate, the evidence points to a few consistent things. Early identification of where you are struggling, so that support can start before an exam attempt rather than after a failure. Targeted support focused on your specific weak areas rather than general revision. Deliberate familiarity with the exam format, since format-familiarity is part of the gap. And structured, specific feedback that tells you what to change, rather than a bare score. None of these is a quick fix, but they are the levers the research and the support literature consistently identify.
Where personalised practice fits
A judgement-free practice environment with per-topic diagnostics is one form of the early, targeted support the evidence points to, and iatroX is built to provide that, with free sample questions to try at iatroX. It is worth being clear about the limits of that claim: no question bank or app closes an attainment gap that is rooted in training background, language, and context, and anyone who tells you otherwise is overselling. Personalised practice can be one useful part of a wider support structure; it is not a substitute for one.
Resources and communities
Support also comes from people. Peer networks for IMGs are a valuable source of both practical guidance and encouragement, including the Nigerian Doctors in the UK (NDUK) community and other diaspora and specialty groups, alongside the induction and support offered by deaneries and the RCGP. Connecting early with others who have navigated the same exams, and with formal support in your training programme, is consistently one of the most useful steps a candidate can take.
Frequently asked questions
What is differential attainment? It is the persistent gap in exam and progression outcomes between groups of candidates, in this context between UK graduates and international medical graduates, that is not explained by differences in ability or motivation.
How big is the MRCGP attainment gap? In 2022/23 the AKT pass rate was 85% for UK graduates and 56% for IMGs, a 29-point gap, with a similar gap in the consultation assessment. It has persisted across multiple years.
Why do IMGs pass at lower rates? Research links it to structural factors: the language of the primary qualification, familiarity with UK guidelines, the NHS context, and the exam format, plus the load of being assessed in a second language. The causes are not fully understood, but are not about ability.
What helps close the gap for an individual? Early identification of weak areas, targeted support rather than general revision, deliberate exam-format familiarity, structured feedback, and connecting with peer support and formal programmes.
Can a question bank fix differential attainment? No. No product closes a gap rooted in training background, language, and context. Personalised, judgement-free practice can be one useful part of a wider support structure, not a substitute for it.