Levelling up medical education: getting comfortable with being uncomfortable

Vijay Nayar

doi:10.3399/bjgp22X721217

The term differential attainment has become part of the vernacular for medical educators. It describes the unexplained variation in the attainment of groups of individuals who share protected characteristics when compared with groups who do not share the same characteristic. Differential outcomes have been identified as being related to age and sex, but by far the largest differentials are for those from ethnic minority backgrounds and in particular for those who have qualified abroad. It exists in both undergraduate and postgraduate contexts, across recruitment outcomes, progression through training, and in exam pass rates.¹

DIFFERENTIAL ATTAINMENT

Previous studies have found that the odds of exam failure in non-white ethnicity doctors and medical students was 2.5 times higher than for white candidates.² Recruitment data for specialty training posts shows that doctors from ethnic minority backgrounds are less likely than white colleagues to be considered appointable (53% versus 75%).³ Progression through specialty training, as judged by Annual Review of Competence Progression (ARCP) outcomes, shows that unsatisfactory outcomes (2018/19) are 10% more likely for international medical graduates (IMGs).⁴ This manifests as extensions to training, and Health Education England (HEE) data for general practice shows that three-quarters of trainees requiring an extension to training (2021/22) were non-UK graduates, as well as over two-thirds being from an ethnic minority background (personal communication, HEE, 2022). Aggregated postgraduate exam rates (2018/19) have been estimated to be lower for UK qualified ethnic minority doctors compared to their white peers (−12.3%), and even lower …

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