Nine out of ten foreign-educated doctors fail the knowledge test

Almost no doctors in Sweden who have received their education abroad passed the knowledge test in November. It is one of the worst results the group has ever achieved. However, the failed doctors reject the criticism and argue that they were given questions that are “completely clinically irrelevant”.

Criticism of immigrant doctors not meeting the standards has been around for a long time. In addition to the fact that medical education in many countries is significantly lower compared to that in Sweden, extensive cheating with fabricated exams has been uncovered.

Ensuring quality and exposing cheaters

The knowledge test for foreign-educated doctors is meant to ensure that no cheaters or poorly educated doctors enter Swedish healthcare, with serious consequences for patients as a result. But among those who are required to take the test, there has been a great deal of dissatisfaction – they believe it is too difficult and that we set too high demands for doctors to be able to do their job.

Defenders of the test argue instead that the consistently abysmal results – on average only 2 out of 10 pass the test – show that it is a bad idea to have labor immigration in the medical field. This year’s even worse result, where only 1 out of 10 passed, supports their argument but also provides ammunition for those who believe the test is too difficult.

Difficult but not unreasonably difficult

The fact is, however, that 19 out of 185 people passed the test. At Umeå University, which is responsible for the test, they do not disclose if there is any pattern in who passes and who does not. The fact that between 10 and 20 percent still pass can be interpreted as the test being difficult but at the same time not unreasonably difficult for those with a solid medical education who make an effort.

Magnus Hultin at Umeå University tells Läkartidningen that he finds it “sad” that so few foreign-educated doctors pass the test, but does not want to speculate on why so few pass it or take it as a reason to lower the requirements.

– We haven’t had time to do a deeper analysis yet, but we are very curious about why it turned out this way, and if there is any explanatory model for what we see. Nothing has changed in how we develop questions, and the test maintains the same quality as before, he says.

Issue with the test or something else

Emelie Bergman Røthe, who studied to be a doctor in the UK, did not pass the Swedish test. She suggests that it is a sign that there is an issue with the test and not with her or her education, as she completed it in a highly developed Western country.

Emelie also blames Brexit, which occurred in the middle of her education. If the UK had remained in the EU, she would have been exempt from taking the test, and her lack of professional skills would have gone unnoticed. Only doctors educated outside the EU/EEA need to prove that they can do their job.

Do not understand the questions – do not master Swedish

Others who fail have worked as doctors for a longer time in their home countries. They argue that the Swedish knowledge test “focuses too much on preclinical aspects”, i.e., on things they studied at the beginning of their education but have forgotten. Others argue that it is not an excuse, and that in that case, they should brush up on their basic knowledge and refresh their skills before the test.

Others excuse their failure by not mastering the Swedish language and therefore not understanding the questions. Being a foreign-educated doctor is in most cases, but not always – as in Emelie’s case – the same as being an immigrant. Defenders of the test also do not consider this a valid excuse – if one does not understand the test questions, there is a high risk that they will not understand other things when they enter healthcare, with the risk of misunderstandings, incorrect treatments, and jeopardized patient safety.

Want to be guided to medical certification

Emelie and others who have not passed the knowledge test believe that the responsibility should lie more with Umeå University than with themselves to succeed. They want to be guided or “spoon-fed” through what they describe as the “crooked journey towards Swedish certification”.

– Provide more educational material or offer more preparatory courses! 90 percent should not have to fail, says Emelie, who claims to be “shocked” that she did not pass the test.

No more than what is required of Swedish-educated doctors

However, Magnus Hultin does not agree that it is the university’s responsibility to ensure that those taking the test have sufficient knowledge. He does not think the knowledge test is too difficult but in line with what is required of doctors educated in Sweden.

– These are the same types of questions that students in the regular medical program have to answer. But my experience is that one often overestimates their own ability to analyze new questions. Coming from a different culture and also having an old education, one needs to study and also practice reading comprehension to see the nuances in the questions, he concludes.