Dr Katherine Woolf, Senior Lecturer in Medical Education at UCL Medical School’s Research Department of Medical Education reports on her team’s recent research, commissioned by the GMC, into factors which can impact on the progress of doctors from minority ethnic and overseas backgrounds.
Doctors’ ethnic background significantly affects outcomes in medical training
Doctors from minority ethnic groups have poorer outcomes compared to white doctors, even those who graduate from a UK medical school: they are more likely to fail exams, less likely to progress smoothly through their training, and are less likely to be successful in job applications. Doctors who went to medical school overseas also have poorer outcomes on average compared to doctors who went to medical school in the UK. This phenomenon is called ‘differential attainment’.
As a psychologist and medical educationalist working in UCL Medical School’s Research Department of Medical Education, I’ve spent the last 13 years trying to find out why differential attainment exists, and what can be done to improve fairness and outcomes for minority ethnic doctors.
Minority ethnic doctors face additional risks that can impact on their training
Our previous research identified several additional risks that minority ethnic doctors and doctors from overseas can face in their training and which prevent them achieving. These include lack of support from seniors due to difficulties fitting in; fear of unconscious bias in examinations, recruitment, and Annual Reviews of Competence Progression (ARCPs); and isolation from social support at work and at home.
Addressing the risks
We wanted to find out how these risks could be addressed, so in the autumn of 2016 we showed the risks to 29 participants from 11 Medical Royal Colleges and 2 participants from the organisation NHS Employers. We asked them to tell us how significant they thought the risks were, and how easy or difficult it would be to remove or mitigate them.
Medical Royal Colleges are the professional bodies that design curricula; they also set the examinations doctors need to take to qualify as specialists or GPs. NHS Employers provides advice and guidance on workforce issues for NHS trusts in England.
Risks are seen as significant and difficult to change
The risks that minority ethnic UK doctors and overseas graduate doctors face were felt to be significant, and participants believed those risks could be difficult to change in many instances. There were two main barriers to change: taboos and the isolation of good practice.
Taboos around ‘race’ and ethnicity
People tend to overlook the fact that British minority ethnic doctors have poorer outcomes on average, focussing instead on the difficulties faced by doctors from overseas who come to work in the UK, which were felt to be easier to explain.
Although participants from medical colleges felt that their organisations should be, and were trying to be open and honest about ethnic differences in outcomes, there was trepidation about being too open about the challenge without being able to identify a solution.
This trepidation is also felt by both trainers and trainees; trainers could feel anxious bringing up problems with their minority ethnic or overseas trainees in case they were accused of racism, whereas minority ethnic trainees or those from overseas worried about being stigmatised if they said they were having problems, especially if they felt those problems related to racism.
Initiatives to improve outcomes are isolated and rarely evaluated
The second major barrier to progress was the isolation of good practice and initiatives to improve fairness. Our participants talked about 63 schemes that they knew of to improve outcomes (and our report contains several examples), but these were too often local, not properly evaluated, or not known about outside a single specialty or region.
What needs to happen next
This research and our previous research suggest the following can improve outcomes for BME UK graduates and IMGs:
- more openness around discussing ‘race’, especially in relation to UK graduates;
- more sharing across the medical profession of initiatives and good practice;
- better access to and understanding of information on differential attainment in examinations, but also in training, recruitment, and workplace-based assessment;
- more support for trainers, who are crucial to trainees’ learning;
- increasing social support for trainees by improving work-life balance and reducing stigmas around asking for and accepting help.
The GMC is committed to ensuring that pathways through medical education and training are valid, fair and justified. Find out about our comprehensive work programme which is already working to deliver many of the recommendations in Dr Woolf’s research, including increasing key stakeholders’ access to information, evidence and examples of good practice.