Dr. Rupal Shah - Associate Dean of the Professional Development Team in London for Health Education England
In medicine in the UK, there are marked discrepancies in postgraduate exam pass rates, acceptance rates onto specialty training programmes, and successful progression through specialty training between White UK; Black, Asian and Minority Ethnic (BAME) UK; and International Medical Graduates.
“Research suggests that factors such as identity, inclusion, social interaction and unconscious bias may help to provide an explanation for differences in attainment among medical graduates”
While the average postgraduate exam pass rate among all UK medical graduates is 71% (UK General Medical Council Annual Report, 2015), a breakdown shows that this statistic:
Rises to almost 76% for White UK medical graduates;
Falls to around 63% for BAME UK medical graduates; and
Falls to around 41% for International Medical Graduates.
BAME UK medical graduates are also less likely to be accepted onto specialty medical training programmes on their first attempt at 72% versus 81% for their White UK counterparts. Research suggests that factors such as identity, inclusion, social interaction and unconscious bias may help to provide an explanation for these differences.
“Differential attainment is the gap between attainment levels of different groups of doctors. Differentials that exist because of ability are expected and appropriate. Differentials connected solely to age, gender or ethnicity of a particular group are unfair” (UK General Medical Council).
Health Education England (HEE) is a national leadership organisation for education, training and workforce development in the health sector. At HEE London, we have created a differential attainment toolkit designed to assist clinicians in tackling ethnic gaps in attainment in their individual work settings (see here), which is being disseminated to NHS hospital trusts across London. Its aims are to:
Promote trainers’ understanding of differential attainment, research findings, cultural safety, cultural humility and possible ways forward;
Facilitate challenging conversations between trainers and trainees about their progress, which is frequently cited as a key area of difficulty;
Provide support with revision and exam preparation, which are very common problem areas for trainees that can have a knock-on effect on confidence and performance; and
Provide career coaching approaches with the aim of optimising and supporting the career development of trainees and potentially reducing differential attainment in specialty medicine recruitment.
“We need to find ways of increasing belonging, reducing bias and noticing individual strengths”
We have also organised a series of workshops available to all health care trainers across London, aimed at raising awareness of attainment issues related to ethnicity and to support the development of solutions to this issue within medicine.
While data collection is in its early days, feedback from workshops on the differential attainment toolkit to date has been very positive, with trusts employing a multitude of approaches to tackling the ethnic attainment issue, including successful mentorship, education and social integration programmes.
To close the differential attainment gap, we need to find ways of increasing belonging, reducing bias and noticing individual strengths within our profession; and I hope we will come closer to achieving this as a result of the discussions we have started around differential attainment.
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