Research conducted by the Medical School’s RDME Unit (Research Department of Medical Education) had shown how ethnicity and country of medical school training impacts on the progression of doctors in the UK.
Katherine Woolf, Rowena Viney, Antonia Rich, Sarah Needleman and Ann Griffin worked on the research which was commissioned by the General Medical Council (GMC). Katherine explains the background to the research and provides an overview of the main findings below, in an article reproduced from her GMC blogpost.
A psychologist and medical educationalist by training, I’ve spent the last 12 years studying medical students’ and doctors’ performance. During that time I’ve focused on exploring why medics from black and minority ethnic (BME) backgrounds – even those who are born and brought up in the UK – underperform academically compared to white medics on average. This phenomenon is known as ‘differential attainment’, and understanding why it happens is a crucial first step towards making medical education fairer and ultimately to improving healthcare.
Individual-level factors and direct examiner bias are not main causes of differential attainment
To date, research has shown that the main causes of ethnic differences in attainment in medical school exam results are not individual-level factors such as students’ previous performance in exams (e.g. at A level and GCSE), type of school attended, parents’ socioeconomic group, first language, personality, learning habits, or motivation for becoming a doctor. We also know the difference can’t just be caused by examiner prejudice in face-to-face clinical examinations because the effect is present in machine-marked multiple choice examinations too.
Instead it seems that medical students’ and doctors’ experiences of learning medicine – what actually happens during medical school and on the wards – are important. For example, previous research has shown that BME medical students can face negative stereotyping from teachers and colleagues, and that BME and white medical students’ social environments differ in terms of their friendships and their relationships with teachers.
Exploring junior doctors’ experiences of learning medicine
The General Medical Council commissioned our team at UCL Medical School to interview 137 doctors (96 trainees and 41 trainers), from different ethnic and national backgrounds working in England and Wales, about their experiences of postgraduate medical training. As well as looking at ethnic differences within UK medical graduates we explored differences between international medical graduates and UK graduates, since evidence suggests that doctors who trained abroad tend to underperform academically.
Three key causes of differential attainment
We found that while most doctors from all backgrounds had experienced challenges during their medical training, international graduates and BME doctors who graduated in the UK faced more challenges that negatively affected their learning and performance.
Three key findings were:
- Cultural differences and subtle unconscious bias against trainees who didn’t ‘fit the mould’ could affect doctors’ ability to get the support and encouragement they needed to learn and develop, particularly in stressful and chaotic NHS work environments.
- While reports of overt racism were rare, unconscious bias was felt to hinder success in recruitment and assessments.
- In a system where success in recruitment and exams determines where in the country you can get a job, and where work-life balance is often poor, UK BME and international graduates were more likely to face separation from family and support outside of work, and reported more mental health problems as a result of work.
In addition to these three key findings, we found that international graduates could face hurdles due to working in a different culture and assessment system.
Dismantling barriers so we can all benefit from the diversity of the medical profession
Differential attainment suggests we may not be getting the best out of our diverse workforce, and that is particularly problematic when the state of the workforce directly affects the health of the nation. Medicine is one of the most ethnically diverse professions. To ensure that we can all benefit from this diversity, we need to act now to reduce prejudice and unconscious bias, increase equality of opportunity during medical training, and dismantle the additional unfair barriers that black and minority ethnic medical students and doctors can face throughout their careers.
Read more about this latest research by the UCL team here.
Dr Katherine Woolf, Senior Lecturer in Medical Education