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Perceived causes of differential attainment in UK postgraduate medical training: a national qualitative study
  1. Katherine Woolf,
  2. Antonia Rich,
  3. Rowena Viney,
  4. Sarah Needleman,
  5. Ann Griffin
  1. Research Department of Medical Education, UCL Medical School, London, UK
  1. Correspondence to Dr Katherine Woolf; k.woolf{at}


Objectives Explore trainee doctors’ experiences of postgraduate training and perceptions of fairness in relation to ethnicity and country of primary medical qualification.

Design Qualitative semistructured focus group and interview study.

Setting Postgraduate training in England (London, Yorkshire and Humber, Kent Surrey and Sussex) and Wales.

Participants 137 participants (96 trainees, 41 trainers) were purposively sampled from a framework comprising: doctors from all stages of training in general practice, medicine, obstetrics and gynaecology, psychiatry, radiology, surgery or foundation, in 4 geographical areas, from white and black and minority ethnic (BME) backgrounds, who qualified in the UK and abroad.

Results Most trainees described difficult experiences, but BME UK graduates (UKGs) and international medical graduates (IMGs) could face additional difficulties that affected their learning and performance. Relationships with senior doctors were crucial to learning but bias was perceived to make these relationships more problematic for BME UKGs and IMGs. IMGs also had to deal with cultural differences and lack of trust from seniors, often looking to IMG peers for support instead. Workplace-based assessment and recruitment were considered vulnerable to bias whereas examinations were typically considered more rigorous. In a system where success in recruitment and assessments determines where in the country you can get a job, and where work–life balance is often poor, UK BME and international graduates in our sample were more likely to face separation from family and support outside of work, and reported more stress, anxiety or burnout that hindered their learning and performance. A culture in which difficulties are a sign of weakness made seeking support and additional training stigmatising.

Conclusions BME UKGs and IMGs can face additional difficulties in training which may impede learning and performance. Non-stigmatising interventions should focus on trainee–trainer relationships at work and organisational changes to improve trainees’ ability to seek social support outside work.

  • EDUCATION & TRAINING (see Medical Education & Training)
  • postgraduate education
  • ethnicity
  • diversity
  • international medical graduate

This is an Open Access article distributed in accordance with the terms of the Creative Commons Attribution (CC BY 4.0) license, which permits others to distribute, remix, adapt and build upon this work, for commercial use, provided the original work is properly cited. See:

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  • Contributors KW and AG designed the study in response to a tender from the General Medical Council. RV, AR, KW and SN carried out the field work. RV, AR and KW analysed and interpreted the data with input from AG and SN. KW drafted the manuscript and is the guarantor. All authors revised it critically for important intellectual content and approved the final version for publication. All authors agree to be accountable for all aspects of the work.

  • Funding The research was funded by the General Medical Council who were involved in designing the study, were kept informed of progress with the collection, interpretation and analysis of the data, and approved this report before submission. The researchers remained independent from the funders.

  • Competing interests All authors have completed the ICMJE uniform disclosure form at and declare: all authors except SN had financial support from the General Medical Council who commissioned this research; KW receives a fee as educational consultant to the Membership of the Royal College of Physicians (UK) Examination.

  • Ethics approval University College London Ethics Committee reference: 0511/11.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Data sharing statement No additional data are available.