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Organisational perspectives on addressing differential attainment in postgraduate medical education: a qualitative study in the UK
  1. Katherine Woolf1,
  2. Rowena Viney1,
  3. Antonia Rich1,
  4. Hirosha Jayaweera1,2,
  5. Ann Griffin1,3
  1. 1 Research Department of Medical Education, UCL Medical School, Royal Free Hospital, London, UK
  2. 2 Centre for Clinical Research in Neuropsychiatry, University of Western Australia, Crawley, Western Australia, Australia
  3. 3 Research Department of Medical Education, UCL Medical School, London, UK
  1. Correspondence to Dr Katherine Woolf; k.woolf{at}


Objectives To 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.

Design Qualitative semistructured individual and group interview study.

Setting Postgraduate medical education in the UK.

Participants Individuals with roles in examinations and/or curriculum design from UK medical Royal Colleges. Employees of NHS Employers.

Results Representatives 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.

Conclusions Representatives 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.

  • medical education & training;
  • health policy
  • quality in health care
  • equality
  • differential attainment
  • ethnicity

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  • Contributors KW and AG designed the study with input from the General Medical Council. RV, AR, KW and HJ carried out the field work. RV, AR, HJ and KW analysed and interpreted the data with input from AG. 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 with grant number of GMC229. The researchers remained independent from the funders. A version of the findings was published on the GMC website in 2016.

  • Competing interests HJ 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.

  • Patient consent Detail has been removed from this case description/these case descriptions to ensure anonymity. The editors and reviewers have seen the detailed information available and are satisfied that the information backs up the case the authors are making.

  • Ethics approval Ethical approval was granted by UCL Research Ethics Committee (Ref: 0511/012).

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

  • Data sharing statement No additional data available.

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