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EXCLUSIVE: Clinical Negligence experts may have deficient knowledge of their area of expertise in new figures from the GMC and HEE. 2018 – Dr Mark Burgin

02/08/18. Dr Mark Burgin discusses the implications for courts of the results of freedom of information requests on three groups of doctors sitting a knowledge test.

Recent figures of knowledge tests from the General Medical Council and Health Education England freedom of information requests show that some doctors appear to have gaps.

There are three groups of doctors who have undergone knowledge assessment, one with known performance issues undergoing investigation by the GMC who were expected to have poor results.

The results showed out of 550 doctors with known performance issues only 23% were fully fit to practice, 60% were fit to practice on a limited basis and 17% were not fit to practice.

The other two groups are doctors who were not known to have performance issues either directly revalidated by the GMC or assessed by Health Education England (HEE).

The performance of doctors without performance issues was much better and of a total of 55 doctors (since 2016) 65% met the standard of the GMC examination.

Another group of doctors without performance issues are those who have been assessed by Health Education England for the GP Induction and Refresher scheme.

The results for the 216 doctors who have set the knowledge test examination since 2016 was that 176 (81.5%) passed after three attempts.

These two groups are not likely to be completely typical of medical experts who are likely to perform better due to need to keep up to date in their medical legal work.

Knowledge gaps

Global measures of knowledge have a limitation as they only tell us whether the doctor reached the standard overall but not if there were knowledge gaps.

Some commercial knowledge tests subdivide the total marks into areas so that the doctor can identify their gaps and remediate or avoid those areas.

The low numbers of doctors who have sat a knowledge test in the last 10 years means that courts cannot be certain that an expert has not strayed from their expertise.

Doctors must study for a minimum of 50 hours of professional development a year which some consider too little to maintain expertise in several areas.

As doctors specialise on increasingly narrow areas of knowledge the role of a generalist to provide a common-sense overview is becoming a necessity.

Specialists are said to know everything about nothing whereas a generalist knows nothing about everything so together they can assist the court avoid knowledge gaps.


Expertise is more than knowledge and includes experience of the issues raised in the case and recognising how practice at the time of the events may have changed.

The court does however rely upon the medical expert to be right about the medical facts that are presented and cannot check every fact in the report even if given a list of references.

As medical practice becomes more pressured it becomes harder for a practitioner in clinical practice to keep up to date and reflect upon the cases they see.

Courts presently rely upon the expert being of good standing with their regulator, having experience of the area of medicine and having sat examinations decades before.

Should the court request that the expert provides evidence of recent (in the last 10 years) knowledge tests rather than appraisal and CPD as evidence that they are up to date?

In view of the results of these FOI requests it may be reasonable for a court to ask for proof that the expert in front of them has sufficient knowledge.

What should clinical negligence lawyers do?

When choosing an expert the clinical negligence lawyer should look at three areas - at least 5 years of clinical practice, recent knowledge tests (ideally broken down by area) and written work.

The correct balance of experience, knowledge and research depends on the individual case and experts should advise when cases are outside of their expertise.

The lawyer should be concerned when an expert has no relevant experience, no recent test or no written work and seek further evidence of expertise.

A knowledge test can be obtained privately from a number of commercial companies who provide a paper similar to the official exam of that speciality sat in examination conditions.

The relevance and extent of the written work are important considerations as is the prestige of the journal that the expert has written for as they demonstrate applied learning.


I have been told that no studies have been carried out to look at random samples of practising doctors so these figures must be taken with a degree of caution.

There have been a series of cases where medical experts have been criticised most notably Dr. Waney Squier who was later struck off by the GMC.

These cases reflect the difficulty faced by clinical negligence lawyers in determining whether their expert has the required level of knowledge to perform their duty.

It is difficult for a clinical negligence lawyer to challenge the expert on medical matters even if they have commissioned an audit of the expert’s report from another expert.

Knowledge tests even expressed as a percentage can give the CN lawyer reassurance that their expert will have the required knowledge when in joint conference or in the courtroom.

Doctor Mark Burgin, BM BCh (oxon) MRCGP is on the General Practitioner Specialist Register.
Dr. Burgin can be contacted for medical expert report audits This email address is being protected from spambots. You need JavaScript enabled to view it. and 0845 331 3304 website

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