The GMC defines differential attainment as the gap between attainment levels of different groups of doctors. It occurs across many professions.
It exists in both undergraduate and postgraduate contexts, across exam pass rates, recruitment and Annual Review of Competence Progression outcomes and can be an indicator that training and medical education may not be fair.
Differentials that exist because of ability are expected and appropriate. Differentials connected solely to age, gender or ethnicity of a particular group are unfair. ( https://www.gmc-uk.org/education/standards-guidance-and-curricula/projects/differential-attainment ).
Dr Woolf et al.:” Postgraduate medical training posed risks to trainees from all ethnic/PMQ groups, but BME UKGs and IMGs faced additional risks in all four categories . Risks were often complexly interrelated, meaning the vulnerability processes which translated risks into poorer outcomes could involve risks from each of the four categories:
- Poorer relationships with seniors and problems fitting in at work can lead to fewer learning opportunities, lower confidence, and increased chance of mental health problems.
- The perception that there is unconscious bias in recruitment, ARCPs, and at work can lead to poorer outcomes, as can anxiety about potential bias.
- Poorer performance in exams and recruitment can mean less autonomy in job choice, increased likelihood of being separated from family and support networks, and increased chance of mental health problems. Failing exams can lower confidence, and resits can be felt to interfere with workplace learning.
- Fear of being labelled as problematic can impede trainees reporting problems, including perceived racism.
- Potential for lack of recognition from trainers about environmental stressors, especially because within medicine there is a belief that failure results from lack of motivation or ability.
IMGs faced additional risks:
- Inexperience with UK assessments, recruitment, UK cultural norms including communication, and NHS/work systems.
- Cultural differences can impede relationships with colleagues and potentially patients, because of unfamiliarity with UK cultural norms, a feeling of not being understood by UKGs, and because trainers can lack confidence in IMGs’ prior training.
- Lengthy time to learn cultural norms.
- Potential stigma of supplementary help.
- Anxiety about increased probability of exam failure.
- Visa difficulties and costs and ineligibility for jobs can reduce training opportunities.”
The evidence all points to the need for tailored support and more understanding of the difficulties faced by IMGs. Training should be fair for all and we should all do our part to make sure it is.
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