Everybody deserves the right to a fair and level playing field. But, as we have said before, there have been inequalities in medical education and training for black, Asian and minority ethnic (BAME) doctors for some time. These inequalities lead to a gap in attainment levels between different groups of doctors. In the medical field, this gap is referred to as Differential Attainment (DA). But in other sectors, it is known as ‘adverse impact’ or ‘group differences’.
When can Differential Attainment occur?
DA can occur in both undergraduate medical education settings and postgraduate contexts across all medical specialties. The General Medical Council (GMC) is the public body committed to protecting patient safety and improving medical education and practice across the UK. According to their research, DA arises from a ‘differential experience throughout every aspect of training’.
Of course, we would expect differentials to exist because of ability. But a gap connected solely to age, gender or ethnicity is unfair.
What is being done to eliminate Differential Attainment?
The GMC has been working with a range of internal and external medical education stakeholders since 2010 to understand the experiences of doctors as they progress through the training pathway. In 2019, Work Psychology Group was commissioned by the GMC to look into the factors that could help eliminate DA.
Work Psychology Group’s work
Our work with the GMC (which has since received an award) focused on understanding the experiences of BAME doctors who had successfully completed their medical training in programmes where DA was not identified as being present.
Victoria Roe, senior consultant and project lead said: “We wanted to learn what had made the difference for these doctors and share this information in a practically focused way for other specialties.
“We interviewed 30 BAME doctors who were in various training programmes across a range of settings where there isn’t an ethnic attainment gap. We asked what supported their success in training. We also interviewed 18 stakeholders and asked for their reflections on why their programme did not show an attainment gap.
“These conversations provided a wealth of examples of what could help level the playing field. They identified a combination of environmental characteristics, people across multiple roles (who support learning) and multiple strategies (that support learning).”
We distilled this down to 10 success factors that were present at an organisational, team or individual level.
- An inclusive workplace that values diversity. A working environment where diversity in all senses (background, culture, experience) is visible and valued.
- Treating learners as individuals. Recognition that an individual’s background and experiences in and out of work will meaningfully impact progression through training, providing support where necessary.
- Working with inspirational senior colleagues. Access to senior colleagues who act as informal role-models, mentors or career coaches to help learners access opportunities and develop.
- The supportive trainer or supervisor. Trainers and supervisors who encourage and support learners in the workplace with their development.
- Having the support and validation of peers. Accessing a network of peers who can improve learning, make sense of experiences and provide advice and guidance on the practicalities of training.
- Working arrangements that facilitate learning. Shifts, rotas and work structures that support learners to build meaningful relationships with team members and dedicate time to learning.
- Maximising the value of learning. Ensuring learning at work and in training is valuable, holistic and helps inform career choices.
- Gaining clarity, certainty and support for career choices. Accessing experiences, knowledge and learning and development opportunities that support informed decisions about career choices or next steps.
- Support to pass exams or deal with exam failure. Being prepared and supported to navigate the process of completing challenging professional exams.
- Personal motivation and drive. Drawing on personal commitment, drive and motivation to succeed in training.
Victoria added: “Closing the gap that BAME doctors experience in availability or access to these success factors, or increasing their options to benefit from them, is a critical next step.
“The findings show there is potential for these success factors to be present in every training environment. The results did not indicate some specialties, programmes or education contexts are somehow more ‘inoculated’ against DA.
“Whilst there is agreement that the success factors will support all learners to succeed in training, there was also a view from learners, borne out by the research literature, that accessing such support can be more challenging for those from a BAME background.”
Victoria concluded: “Until support is equally accessible to all learners, it is likely that attainment gaps will continue to exist across medical programmes.”
Professor Helen Stokes-Lampard, Chair of the Academy of Medical Royal Colleges, added: “We know that any one part of the health education system – medical schools, deans, colleges, employers – cannot solve the problems alone. Indeed, this is not an issue that healthcare itself can fully address – these are not challenges unique to healthcare and these problems are identified in many other sectors.
“However, all of us involved in healthcare education have a responsibility to work together and do what we can to identify and then address why it is that so many of our BAME medical colleagues are deriving less value from their education and training which in turn results in poorer career progression and continued differential attainment.
“This research commissioned by the GMC is a welcome and important contribution to our understanding. Focussing on the “success factors” is both insightful and of direct practical use. Whilst the context and circumstances may differ across specialties, there are, as so often across medicine, common themes and issues. I am sure that all specialties will be able to learn from the excellent examples set out in the report.”
You can read the full report on the GMC’s website.