Perceived causes of differential attainment in UK postgraduate medical training: a national qualitative study

Woolf, Katherine; Rich, Antonia; Viney, Rowena; Needleman, Sarah; Griffin, Ann

doi:10.1136/bmjopen-2016-013429

Cited by 84 publications

(137 citation statements)

References 30 publications

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“…Although these differences are well known, explanations are lacking17 and are the subject of ongoing research 18. For all candidates there was a strong negative association between the number of attempts and the pass rate: initial failure was associated with a higher risk of further failure so for candidates with a diagnosis of dyslexia after initial failing the examination, the likelihood of passing the AKT was already lower.…”

Section: Discussionmentioning

confidence: 99%

Performance of candidates disclosing dyslexia with other candidates in a UK medical licensing examination: cross-sectional study

Asghar

Siriwardena

Elfes

et al. 2018

Postgraduate Medical Journal

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Section: Discussionmentioning

confidence: 99%

Performance of candidates disclosing dyslexia with other candidates in a UK medical licensing examination: cross-sectional study

Asghar

Siriwardena

Elfes

et al. 2018

Postgraduate Medical Journal

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“…Participants were given an information sheet about the study, and then asked to read the executive summary of part 1 of the research which included the 12 risks to trainee progression 3. They then completed an online questionnaire, rating each risk for significance and amenability to change on a five-point scale (from very significant/very difficult to change to very insignificant/very easy to change).…”

Section: Methodsmentioning

confidence: 99%

“…It is well established that international medical graduates (IMGs), on average, have poorer academic and career progression compared with UK medical school graduates (UKGs), and black and minority ethnic (BME) doctors also have poorer outcomes compared with white doctors1 2 (see also Woolf et al 3 for a review). This differential attainment came into the spotlight in 2014 when the British Association of Physicians of Indian Origin brought the Royal College of General Practitioners and the General Medical Council (GMC) to judicial review over the low pass rates of IMGs in the Membership of the Royal College of General Practitioners Examination (MRCGP)4 following a 2013 review of the MRCGP commissioned by the GMC5 and a subsequent article by the review authors in the British Medical Journal 6…”

Section: Introductionmentioning

confidence: 99%

“…That work identified six risks to the progression of BME UKG and IMG trainees, and an additional six risks that only affected IMG (see box 1). 3 In part 2, the current study, we explore how these risks are perceived by representatives of stakeholder organisations with responsibility for training and assessing doctors undertaking specialist training (medical Royal Colleges), and for the human resources aspects of employing doctors in training in England (NHS Employers).…”

Section: Introductionmentioning

confidence: 99%

“…Reproduced from Woolf et al 3

Risks to the progression of BME UKG and IMG trainees

Poorer relationships with seniors and problems fitting in at work, sometimes because of unconscious bias, that can lead to fewer learning opportunities, lower confidence and increased chance of mental health problems.Bias in recruitment, Annual Review of Competence Progression (ARCP) and at work could result in poorer outcomes.Anxiety about potential bias could result in poorer outcomes.Less autonomy in job choice resulting from poorer performance in examinations and recruitment can mean increased likelihood of being separated from family and support networks, and increased chance of mental health problems.Fear of being labelled as problematic can impede trainees reporting or getting help for 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.

Risks to the progression of IMG trainees only

Inexperience with UK assessments, recruitment, UK cultural norms including communication and National Health Service/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 examination failure.Visa difficulties and costs, and ineligibility for jobs can reduce training opportunities.

…”

Section: Introductionmentioning

confidence: 99%

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Organisational perspectives on addressing differential attainment in postgraduate medical education: a qualitative study in the UK

et al. 2018

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ObjectivesTo explore how representatives from organisations with responsibility for doctors in training perceive risks to the educational progression of UK medical graduates from black and minority ethnic groups (BME UKGs), and graduates of non-UK medical schools (international medical graduates (IMGs)). To identify the barriers to and facilitators of change.DesignQualitative semistructured individual and group interview study.SettingPostgraduate medical education in the UK.ParticipantsIndividuals with roles in examinations and/or curriculum design from UK medical Royal Colleges. Employees of NHS Employers.ResultsRepresentatives from 11 medical Royal Colleges (n=29) and NHS Employers (n=2) took part (55% medically qualified, 61% male, 71% white British/Irish, 23% Asian/Asian British, 6% missing ethnicity). Risks were perceived as significant, although more so for IMGs than for BME UKGs. Participants based significance ratings on evidence obtained largely through personal experience. A lack of evidence led to downgrading of significance. Participants were pessimistic about effecting change, two main barriers being sensitivities around race and the isolation of interventions. Participants felt that organisations should acknowledge problems, but felt concerned about being transparent without a solution; and talking about race with trainees was felt to be difficult. Participants mentioned 63 schemes aiming to address differential attainment, but these were typically local or specialty-specific, were not aimed at BME UKGs and were largely unevaluated. Participants felt that national change was needed, but only felt empowered to effect change locally or within their specialty.ConclusionsRepresentatives from organisations responsible for training doctors perceived the risks faced by BME UKGs and IMGs as significant but difficult to change. Strategies to help organisations address these risks include: increased openness to discussing race (including ethnic differences in attainment among UKGs); better sharing of information and resources nationally to empower organisations to effect change locally and within specialties; and evaluation of evidence-based interventions.

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Gender, flexibility and workforce in the NHS: A qualitative study

Chekar,

Brewster,

Lambert

et al. 2024

Health Planning & Management

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Data from the General Medical Council show that the number of female doctors registered to practise in the UK continues to grow at a faster rate than the number of male doctors. Our research critically discusses the impact of this gender‐based shift, considering how models of medical training are still ill‐suited to supporting equity and inclusivity within the workforce, with particular impacts for women despite this gender shift. Drawing on data from our research project Mapping underdoctored areas: the impact of medical training pathways on NHS workforce distribution and health inequalities, this paper explores the experiences of doctors working in the NHS, considering how policies around workforce and beyond have impacted people's willingness and ability to continue in their chosen career path. There is clear evidence that women are underrepresented in some specialties such as surgery, and at different career stages including in senior leadership roles, and our research focuses on the structural factors that contribute to reinforcing these under‐representations. Medical education and training are known to be formative points in doctors' lives, with long‐lasting impacts for NHS service provision. By understanding in detail how these pathways inadvertently shape where doctors live and work, we will be able to consider how best to change existing systems to provide patients with timely and appropriate access to healthcare. We take a cross‐disciplinary theoretical approach, bringing historical, spatiotemporal and sociological insights to healthcare problems. Here, we draw on our first 50 interviews with practising doctors employed in the NHS in areas that struggle to recruit and retain doctors, and explore the gendered nature of career biographies. We also pay attention to the ways in which doctors carve their own career pathways out of, or despite of, personal and professional disruptions.

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Perceived causes of differential attainment in UK postgraduate medical training: a national qualitative study

Cited by 84 publications

References 30 publications

Performance of candidates disclosing dyslexia with other candidates in a UK medical licensing examination: cross-sectional study

Performance of candidates disclosing dyslexia with other candidates in a UK medical licensing examination: cross-sectional study

Organisational perspectives on addressing differential attainment in postgraduate medical education: a qualitative study in the UK

Gender, flexibility and workforce in the NHS: A qualitative study

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