Statement regarding computer-based test (CBT)

Published on 04 May 2023

To make sure internationally educated professionals have the right knowledge and skills to provide high-quality care in the UK, they must take a two-part test of competence before joining our register: a computer-based test (CBT) usually sat in their home country, and a practical test (OSCE) in the UK.

The information below is true as of 04 May 2023. We have since published an updated statement which can be found here: The action we’re taking following concerns about the Yunnik test centre

An organisation called Pearson VUE runs the CBT programme on the NMC’s behalf. It recently alerted us to anomalous data at one of its third-party CBT test centres in Ibadan, Nigeria. Pearson VUE stopped testing at this centre immediately.

A total of 512 people on our register (around five percent of all the professionals on our register who qualified in Nigeria) took their CBT at this test centre. We’re writing to them to set out what’s happened, and to tell them we’re opening cases to determine whether or not they gained fraudulent or incorrect entry to the register.

More people have applied to join the register but are not yet on it, therefore they can’t practise as a nurse or midwife. We’ve paused their applications. We’re writing to these applicants to ask them to retake the test, and to request more information that we’ll use to make a final decision about their application.

Our paramount concern is to maintain the integrity of the register to protect the public. At the same time, it’s critical we approach any investigations about individuals objectively and transparently, avoiding any unfair discrimination.

It’s also important to remember that we’ve not yet made any determinations about individuals.

Pearson VUE has reviewed all data relating to the NMC’s CBT from every test site globally, and there is no evidence of similar activity at any other site.

Andrea Sutcliffe, NMC Chief Executive and Registrar, said:

“Data from one test site in Nigeria is unusual and concerning. We have regulatory processes which we will now follow, and if necessary, we can refuse registration or remove people from our register, to protect the public and people who use health and care services.

“We know the public and people who use services may find this worrying. This affects just over 500 out of the 771,445 professionals on our register. They will all have passed the practical test in this country before they were accepted onto the register and to date no concerns have been referred to us about their fitness to practise.

“We should remember that thousands of nurses and midwives who were educated overseas have safely joined our register recently and continue to provide safe, effective and kind care across the UK.”

What is the CBT?

The NMC uses a Test of Competence (ToC) to assess the skills and knowledge of people applying to join our register from overseas.

This has two main parts: a multiple-choice computer-based test known as the CBT which applicants usually sit in their home country; and a practical test known as the OSCE which people take in the UK.

The CBT is split into two parts: Part A covers numeracy, and Part B covers clinical questions for nursing or midwifery.

A company called Pearson VUE runs the CBT. They’ve been the NMC’s test provider since 2014, when we introduced the test.

How many tests took place at the Ibadan centre?

A total of 1,970 candidates took their CBT at this centre, of whom 512 are on the NMC register.

What action has been taken since these concerns came to light?

Pearson VUE immediately suspended tests at the Ibadan centre. The NMC has since been working urgently with them to examine data and evidence about this. The NMC is also scrutinising the full applications of those who have joined the register.

The NMC is writing to some applicants and professionals on our register to set out what’s happened and what it means for them. The NMC is also opening some cases to determine whether individuals gained fraudulent or incorrect entry to the register.

Are you asking people to retake their test?

The NMC is giving people the option to retake and our test provider is covering the candidate exam fee costs. The NMC can’t make people resit – it will be their decision. If somebody does retake and passes, it won’t guarantee that they’ll gain entry to the register or be able to stay on it, but it will form part of the information the NMC will use to make a final decision.

Are you imposing interim suspension orders?

The NMC will consider the need for interim orders on an evidenced basis as part of each case we’re opening to determine whether or not individuals gained incorrect or fraudulent entry to the register.

What risk is there to patients and people who use services?

We’re looking into concerns and if necessary to manage risk, we can apply to panels to restrict individuals’ practice.

In the meantime it’s worth remembering they will have been subject to additional controls including:

  • sitting the practical OSCE exam, in person, in the UK
  • in-person identity and documentation verification
  • English language checks.

The NMC can also confirm that at this stage, no fitness to practise concerns have been raised about anyone on the register in this group. But clearly, if someone has gained entry to the register incorrectly or fraudulently then the NMC will need to take action.

What does this mean for the individuals affected?

The NMC is approaching investigations about individuals objectively and transparently, avoiding any unfair discrimination. It has not yet made any determinations about individuals. Unless the NMC decide there is sufficient evidence to seek an interim suspension order, individuals will be able to continue to work.

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