Home / Insights Hub / Beyond the Numbers: Addressing Differential Attainment in Medical Education

Beyond the Numbers: Addressing Differential Attainment in Medical Education

Posted on 18/03/2025 Posted by Jess Morgan Post Type Insights

Differential attainment- what do we mean?

Differential attainment 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.
By far the largest differentials are for those from ethnic minority backgrounds and in particular for those who have qualified abroad. Differential attainment exists in both undergraduate and postgraduate contexts, across recruitment outcomes, progression through training and in exam pass rates.

Differential attainment data represent averages and generalisations. Clearly there are many highly performing ethnic minority doctors from both the UK and abroad, just as there are less well performing UK qualified white doctors. However this should not detract from the findings that overall, trainees from ethnic minority backgrounds, international medical graduates (IMGs) and indeed those with disabilities and long-term conditions have a poorer experience and disproportionally worse outcomes from medical training when compared to their peers. These differences exist even after correcting for factors such as language skills, prior academic performance, socioeconomic status, motivational factors, study habits and examiner bias.

68%

An increasingly diverse workforce of new joiners to the medical workforce are non-UK graduates

Moving beyond fear

There’s been little progress in this area over the last 20 years. Worse still, the concept breeds fear. Fear amongst residents of being negatively stereotyped and being in the “demographic” that is going to fail and need an extension. Fear amongst educators of being accused of bias or discrimination when giving feedback. Fear of litigation for colleges and regulators. Addressing differential attainment at a systems level is paramount.
That said, the underlying causes for differential attainment remain far from clear. We need to take a step back and, rather than looking at outcomes, try to understand the experiences of our learners and the curriculum that led to them.

Understanding the root causes

Research has identified many additional challenges faced by ethnic minority doctors and IMGs. There is a perceived risk of unconscious bias in recruitment, assessments, and in their day to day work. IMGs report difficulties in fitting in and poor relationships with their seniors who may assume that they have an inferior prior educational experience. Lack of autonomy about job locations means these doctors are often separated from their family and support networks. A recent BMA survey on racism in the NHS reported that over three-quarters of respondents had experienced racism in their workplace with negative impacts on their wellbeing and career progression. These uncomfortable statistics cannot be ignored.

WHAT CAN WE DO AS EDUCATORS?

A paradigm shift is required if we are to level up medical education.

Bias and privilege

Addressing the lower expectations educators may have of ethnic minority residents and IMGs. This is not just about prejudice, but also about the advantage we give to others (eg attention, training, opportunities). Privilege is not about the benefits you have had but the barriers you have not had to face.

Strengths not deficiencies

Shifting from a deficit model, where there’s a problem to be solved, to strengths-based change where we consider the system to be deficient not the individual.

Early identification

Identifying residents who may require additional support early on and facilitating placements according to need, not their recruitment scores.

Enhanced induction

Induction for IMGs is not just about covering local policies and protocols, but also about helping residents and their families to settle into new communities.

Individualised support

Personalised learning plans and monitoring of wellbeing are essential.

Communication skills

Acknowledging that language is a social construct that helps to create shared meanings and build rapport. This feeds into ARCP outcomes and exam preparation.

Education

Faculty development opportunities around unconscious bias, active bystander training and cultural competence.

Embrace diversity

Tackling issues of discrimination and creating an ethos of psychological and cultural safety which engender inclusion and belonging, with no assault on one’s identity.