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The article explores the factors associated with applying for and receiving offers for urology training in the UK, focusing on demographic, socioeconomic, and educational aspects. It reveals that while gender was associated with receiving an offer, other factors like age, ethnicity, and socioeconomic status did not impact the likelihood of obtaining a post. The study, based on data from the UK Medical Education Database, highlights the need for diversity and inclusion initiatives in surgical training to create a more diverse senior workforce. [Extracted from the article]

BackgroundMethodsResultsConclusionDespite commitment across national medical education and training bodies to tackle differential attainment (DA), alongside a wealth of research into contributing factors and solutions, progression in narrowing the gap has lagged. This study explores the lived experiences of doctors facing DA, career progression barriers and their wider consequences.Interpretative phenomenological analysis was chosen as the methodological framework. The six doctors interviewed were released from General Practice training before enrolling in a ‘targeted’ intervention scheme designed to support them with training completion.The cohort included four international medical graduates and two graduates from the United Kingdom. Three participants were neurodiverse. Three inter-related themes were identified. 1) ‘Career insecurity’ is defined as uncertainty about career prospects and attainment of career goals. At varying points along their journey navigating through progression barriers, participants frequently questioned their futures and the decision to persist in the arduous pursuit of training completion. 2) ‘Psychological injury’ featured prominently in the experiences of the ‘targeted trainees’. Feelings of worthlessness, helplessness, low energy and mood, and ‘traumatic’ experiences were described. 3) ‘Social injury’ illustrates consequences to doctors’ familial and social contexts (including relationships), as well as wider societal consequences (such as attrition).Our research evidences the consequences of DA and career progression barriers. We highlight the urgent need for escalated efforts in addressing the challenges faced by different groups of doctors and narrowing the attainment gap. Recommendations for interventions are included in our study. [ABSTRACT FROM AUTHOR]

Aims: The aims of this study were to describe the demographic, socioeconomic, and educational factors associated with core surgical trainees (CSTs) who apply to and receive offers for higher surgical training (ST3) posts in Trauma & Orthopaedics (T&O). Methods: Data collected by the UK Medical Education Database (UKMED) between 1 January 2014 and 31 December 2019 were used in this retrospective longitudinal cohort study comprising 1,960 CSTs eligible for ST3. The primary outcome measures were whether CSTs applied for a T&O ST3 post and if they were subsequently offered a post. A directed acyclic graph was used for detecting confounders and adjusting logistic regression models to calculate odds ratios (ORs), which assessed the association between the primary outcomes and relevant exposures of interest, including: age, sex, ethnicity, parental socioeconomic status (SES), domiciliary status, category of medical school, Situational Judgement Test (SJT) scores at medical school, and success in postgraduate examinations. This study followed STROBE guidelines. Results: Compared to the overall cohort of CSTs, females were significantly less likely to apply to T&O (OR 0.37, 95% CI 0.30 to 0.46; n = 155/720 female vs n = 535/1,240 male; p < 0.001). CSTs who were not UK-domiciled prior to university were nearly twice as likely to apply to T&O (OR 1.99, 95% CI 1.39 to 2.85; n = 50/205 vs not UK-domiciled vs n = 585/1,580 UK-domiciled; p < 0.001). Age, ethnicity, SES, and medical school category were not associated with applying to T&O. Applicants who identified as ‘black and minority ethnic’ (BME) were significantly less likely to be offered a T&O ST3 post (OR 0.70, 95% CI 0.51 to 0.97; n = 165/265 BME vs n = 265/385 white; p = 0.034). Differences in age, sex, SES, medical school category, and SJT scores were not significantly associated with being offered a T&O ST3 post. Conclusion: There is an evident disparity in sex between T&O applicants and an ethnic disparity between those who receive offers on their first attempt. Further high-quality, prospective research in the post-COVID-19 pandemic period is needed to improve equality, diversity, and inclusion in T&O training. Cite this article: Bone Jt Open 2024;5(8):697–707.

Introduction: International Medical Graduates (IMGs) form an important and valued part of the United Kingdom's (UK) medical workforce but many experience difficult transitions into the National Health Service workforce. Mentoring could support IMGs as they transition into their role as General Practice (GP) trainees but there is a lack of evidence about whether mentoring is an effective intervention for this group. Aim: To evaluate the effectiveness of the NHS Education for Scotland (NES) GP mentoring programme from the perspective of mentors and mentees. Method: Twelve medical educators (the mentors) provided mentoring to 19 IMG GP trainees (the mentees) who were within their first six months of entering GP training in Scotland. Each mentee received four 60-minute mentoring sessions via video conferencing. Results: Mentoring provided tailored support to assist IMG GP trainees' holistic transition into UK General Practice. Mentees appreciated talking to a non-supervisor, receiving non-judgemental support and protected time with a supportive listener to overcome challenges. This had a positive impact, even for those who did not anticipate the need for such support. Mentors supported diverse needs and tailored meetings, experiencing a distinct shift from previous supervisor roles. Their diverse experience enhanced their role and they developed new skills. Conclusion: Mentoring could provide significant support to IMG GP trainees but comes with certain challenges. Future research should evaluate the long-term impact of the NES GP IMG mentoring programme. [ABSTRACT FROM AUTHOR]

Abstract Introduction Solving disparities in assessments is crucial to a successful surgical training programme. The first step in levelling these inequalities is recognising in what contexts they occur, and what protected characteristics are potentially implicated. Methods This scoping review was based on Arksey & O’Malley’s guiding principles. OVID and Embase were used to identify articles, which were then screened by three reviewers. Results From an initial 358 articles, 53 reported on the presence of differential attainment in postgraduate surgical assessments. The majority were quantitative studies (77.4%), using retrospective designs. 11.3% were qualitative. Differential attainment affects a varied range of protected characteristics. The characteristics most likely to be investigated were gender (85%), ethnicity (37%) and socioeconomic background (7.5%). Evidence of inequalities are present in many types of assessment, including: academic achievements, assessments of progression in training, workplace-based assessments, logs of surgical experience and tests of technical skills. Conclusion Attainment gaps have been demonstrated in many types of assessment, including supposedly “objective” written assessments and at revalidation. Further research is necessary to delineate the most effective methods to eliminate bias in higher surgical training. Surgical curriculum providers should be informed by the available literature on inequalities in surgical training, as well as other neighbouring specialties such as medicine or general practice, when designing assessments and considering how to mitigate for potential causes of differential attainment.

Differential attainment (DA) in post graduate medical training is a recognised challenge and refers to unexplained variation across groups when split by several protected characteristics. The Royal College of Radiology is committed to fostering diversity, inclusivity, and equality with the goal of narrowing existing gaps and improving training outcomes. This was a mixed methods study aiming to understand the causes of DA with view to helping the RCR develop strategies to address this. A cross-sectional survey was completed by 140 clinical oncology trainees in September 2022. Trainees and trainers (17 and 6 respectively) from across England, Scotland, Wales and Northern Ireland, took part in focus group and interviews from August to December 2022. Quantitative and qualitative data merged and interpreted. Results showed international medical graduates and trainees from ethnic minority backgrounds were more likely to encounter challenges. The qualitative findings were used to identify three themes through which these problems could be framed. The trainee as a "space invader," the hidden curriculum of clinical oncology training and the process of navigating and tacking the training journey. Differential attainment is the product of a complex interplay between the trainee, trainer, and the training environment. Therefore, interventions must be tailored to different people and contexts. At a national level, the RCR can adopt general policies to promote this such as mentorship programmes, protected time for supervision and cultural competency training. Efficacy of proposed interventions for trial and their impact on DA should be evaluated to drive evidence-based changes. • The GMC and Royal Colleges are committed to bridging existing gaps and addressing differential attainment. • A mixed-method research approach to provide a holistic understanding of differential attainment in Clinical Oncology. • Analysis of exclusionary mechanisms identified three main themes: space invaders, hidden curriculum and navigating. [ABSTRACT FROM AUTHOR]

AbstractPurposeMethodsResultsConclusionDelivering fair and reliable summative assessments in medical education assumes examiner decision making is devoid of bias. We investigated whether candidate racial appearances influenced examiner ratings in undergraduate clinical exams.We used an internet-based design. Examiners watched a randomised set of six videos of three different white candidates and three different non-white (Asian, black and Chinese) candidates taking a clinical history at either fail, borderline or pass grades. We compared the median and interquartile range (IQR) of the paired difference between scores for the white and non-white candidates at each performance grade and tested for statistical significance.160 Examiners participated. At the fail grade, the black and Chinese candidates scored lower than the white candidate, with median paired differences of −2.5 and −1 respectively (both p < 0.001). At the borderline grade, the black and Chinese candidates scored higher than the white candidate, with median paired differences of +2 and +3, respectively (both p < 0.001). At the passing grade, the Asian candidate scored lower than the white candidate (median paired difference −1, p < 0.001).The racial appearance of candidates appeared to influence the scores awarded by examiners, but not in a uniform manner. [ABSTRACT FROM AUTHOR]

Addressing differential attainment between International Medical Graduates (IMGs) and their peers who hold UK Primary Medical Qualifications remains one of the most significant challenges facing postgraduate General Practice (GP) training. Enhanced Induction programme, such as the Scottish Trainee Enhanced Programme (STEP), is one tool designed to try and facilitate transition into training and reduce this inequity. The STEP course is attended by both the trainee and their educational supervisor, and aims to lay the foundations of a successful and supportive supervisory relationship. Previous work has evaluated this programme from the perspective of the trainee. Through the use semi-structured interviews, we evaluated the impact and the benefits of the programme from the perspective of the educational supervisors, building on the literature on interventions to support inequity in medical education. [ABSTRACT FROM AUTHOR]

Background: This study aimed to evaluate core surgical training (CST) differential attainment related to coronavirus disease 2019 (COVID-19), gender and ethnicity. The hypothesis was that COVID-19 adversely influenced CST outcomes. Methods: A retrospective cohort study of 271 anonymised CST records was undertaken at a UK Statutory Education Body. Primary effect measures were Annual Review of Competency Progression Outcome (ARCPO), Membership of the Royal College of Surgeons (MRCS) examination pass and Higher Surgical Training National Training Number (NTN) appointment. Data were collected prospectively at ARCP and analysed with non-parametric statistical methods in SPSS. Results: CSTs numbering 138 completed training pre-COVID and 133 peri-COVID. ARCPO 1, 2 and 6 were 71.9% pre-COVID versus 74.4% peri-COVID (P=0.844). MRCS pass rates were 69.6% pre-COVID versus 71.1% peri-COVID (P =0.968), but NTN appointment rates diminished (pre-COVID 47.4% vs. peri-COVID 36.9%, P=0.324); none of the above varied by gender or ethnicity. Multivariable analyses by three models revealed: ARCPO was associated with gender [m:f 1:0.87, odds ratio (OR) 0.53, P =0.043] and CST theme (Plastics vs. General OR 16.82, P=0.007); MRCS pass with theme (Plastics vs. General OR 8.97, P=0.004); NTN with the Improving Surgical Training run-through programme (OR 5.00, P<0.001). Programme retention improved peri-COVID (OR 0.20, P= 0.014) with pan University Hospital rotations performing better than Mixed or District General-only rotations (OR 6.63, P =0.018). Conclusion: Differential attainment profiles varied 17-fold, yet COVID-19 did not influence ARCPO or MRCS pass rates. NTN appointment fell by one-fifth peri-COVID, but overall training outcome metrics remained robust despite the existential threat. [ABSTRACT FROM AUTHOR]

Background Differential attainment has been widely observed in United Kingdom (UK) medical training, with minority ethnicity being associated with reduced success in recruitment and progression through training. Specialty training in Public Health in the UK recruits candidates with medical as well as non-medical backgrounds. At the request of the UK Faculty of Public Health and Health Education England, we sought to examine whether differential attainment may or may not be occurring in the multi-stage recruitment process. Methods We analysed 3 years of national recruitment data into Public Health specialty training to identify whether demographic characteristics including age, sex, ethnicity and professional background were associated with successful recruitment. Results In total 2252 applications between 2018 and 2020 were analysed. Candidates who were older, Asian, black or from backgrounds other than medicine were significantly less likely to progress from the psychometric testing stage than the white British group. Fewer statistically significant differences were observed at the final stage of recruitment involving interviews, group work and a written task. Conclusions The findings suggest that older candidates those from some ethnic minority backgrounds and those from backgrounds other than medicine are disadvantaged by the current recruitment process, with differential attainment associated with the psychometric testing stage. [ABSTRACT FROM AUTHOR]

The gender and ethnicity attainment gap among undergraduate students in UK higher education is well documented. However, there is very little research examining the international attainment gap despite many universities acknowledging that international students achieve lower grades than home students. Furthermore, evidence for international postgraduate students is almost missing from the literature. This study analysed data on 705 students registered on an online distance learning (ODL) postgraduate programme to explore demographic characteristics and educational experience in relation to grade point average (GPA). The research shows that the strongest predictor of student outcome on this Master's programme was ethnicity and while there was an additional effect of region of birth, classifying students on the basis of 'home' or 'international', is seriously misleading when examining student performance, at least for this postgraduate programme. Postgraduate ODL programmes in the United Kingdom may need to develop additional support to enable particular groups of learners, including international black and ethnic minority (BAME) students to get the most out of their learning experience. [ABSTRACT FROM AUTHOR]

Background: Differential attainment has previously been suggested as being due to subjective bias because of racial discrimination in clinical skills assessments. Aim: To investigate differential attainment in all UK general practice licensing tests comparing ethnic minority with White doctors. Design and setting: Observational study of doctors in GP specialty training in the UK. Method: Data were analysed from doctors' selection in 2016 to the end of GP training, linking selection, licensing, and demographic data to develop multivariable logistic regression models. Predictors of pass rates were identified for each assessment. Results: A total of 3429 doctors entering GP specialty training in 2016 were included, with doctors of different sex (female 63.81% versus male 36.19%), ethnic group (White British 53.95%, minority ethnic 43.04%, and mixed 3.01%), country of primary medical qualification (UK 76.76% versus non-UK 23.24%), and declared disability (disability declared 11.98% versus not declared 88.02%). Multi-Specialty Recruitment Assessment (MSRA) scores were highly predictive for GP training end-point assessments, including the Applied Knowledge Test (AKT), Clinical Skills Assessment (CSA), Recorded Consultation Assessment (RCA), and Workplace-Based Assessment (WPBA) and Annual Review of Competency Progression (ARCP). Ethnic minority doctors did significantly better compared with White British doctors in the AKT (odds ratio [OR] 2.05, 95% confidence interval [CI] = 1.03 to 4.10, P = 0.042). There were no significant differences on other assessments: CSA (OR 0.72, 95% CI = 0.43 to 1.20, P = 0.201), RCA (OR 0.48, 95% CI = 0.18 to 1.32, P = 0.156), or WPBA—ARCP (OR 0.70, 95% CI = 0.49 to 1.01, P = 0.057). Conclusion: Ethnic background did not reduce the chance of passing GP licensing tests once sex, place of primary medical qualification, declared disability, and MSRA scores were accounted for. [ABSTRACT FROM AUTHOR]

Abstract Background Differences exist among doctors in examination performance, clinical and academic career progression, and prevalence of performance assessment by professional regulatory bodies. Some of these differences have been reported in relation to individual characteristics. The purpose of this study is to establish whether any specific individual characteristics are associated with performance in selection for entry into specialty training in Intensive Care in the United Kingdom. Methods We evaluated data of 509 candidates from the national recruitment rounds of 2018/19 and 2019/20. The outcome evaluated was “success at interview". Variables reaching statistical significance at univariate logistic regression analysis were fed in the multivariable analysis to identify independent predictors of success, with additional exploratory analyses performed, where indicated. Results The candidates’ median age was 31.5 (interquartile range, IQR 30–33.7) years, 324 (63.7%) were male, 256 (50.3%) not married/in civil partnership, 6 (1.2%) pregnant. The majority (316, 62.1%) were White British, 99 (19.5%) of Asian background, other ethnicities represented less than 20% of the sample. Of the 509 candidates, 155 (30.5%) were Atheist, 140 (27.5%) Christian; most were heterosexual (440, 86.4%); 432 (84.9%) reported no disability, while 4 (0.8%) had a minor and 1 (0.2%) had a major disability; 432 (84.9%) candidates held a UK medical degree; 77 (15.1%) a non-UK degree. At univariate logistic regression analysis (LRA) multiple factors were found to be associated with a lower likelihood of success, the strongest being an international medical graduate (IMG, holding a non-UK medical degree); others were increasing age, male gender, being married, Asian or mixed ethnicity, specific religious beliefs (Buddhism, Islam and Hinduism). After feeding all factors significant at univariate analysis, the only two retained as independent predictors at multivariable regression were Asian ethnicity and holding a non-UK degree. Asian UK graduates success rate was 92.7%, comparable to the national average of 92.3%, the Asian IMGs success rate was significantly lower, at 45.5%. Conclusions As the imbalances seen within the candidates of Asian background are explained by considering the country of primary medical training, the variations in performance is likely to reflect differences in training systems and understanding of the UK NHS.

International medical graduates (IMGs) have a higher rate of examination failure and are more likely to be referred to the regulator for professional performance issues than their UK-trained counterparts. Support for IMGs to reduce differential attainment takes many forms. A pilot study to assess the feasibility and utility of early intervention to increase the support available for IMGs entering general practice (GP) training was undertaken. IMGs entering GP training in one UK region were offered one-to-one, near-peer linguistic coaching during their first two weeks of training. A session focusing on cultural acclimatisation, local accent and dialect using mock patient consultations was delivered and evaluated. The coaching was valued by the trainees and the intervention allowed very early identification of a trainee who needed further support. It was possible to identify such trainees using a non-medical volunteer student coach. Use of a non-medical, near-peer coach for one-to-one linguistic support has not previously been described for IMGs. This pilot study confirms the acceptability and utility of this approach. Early identification of trainees requiring enhanced support allows targeted interventions in a time-pressured speciality training programme. Further study with a larger-scale and longer-term coaching programme, assessing trainee feedback and uptake of early supportive intervention is recommended. [ABSTRACT FROM AUTHOR]

Presenting the results from a mixed methods case-study, this paper draws together insight from the fields of 'BME attainment' and 'student transition' to explore how differential levels of degree attainment might be experienced within the context of a higher tariff university in England. Across a five-year period (2010/11–2014/2015) it compares the levels of degree attainment between UK-domiciled White and Black and Minority Ethnic (BME) students in relation to prior attainment, qualification type, and socioeconomic group (POLAR 3). A range of qualitative data then outlines a series of dynamic factors that can, when compounded, serve to constrain BME students' capability to negotiate their way through very particular university landscapes. These include: academic expectation and preparedness; the pedagogic terrain; pastoral engagement and sense of belonging finance; and, the lived experience of diversity and 'othering'. The paper argues that attainment gaps should not be viewed in terms of an individual deficit that needs to be 'fixed' or 'filled'. Instead, greater attention needs to be directed toward enhancing the capacity of higher tariff universities to respond positively to the needs of a changing demographic. [ABSTRACT FROM AUTHOR]

Many medical schools are transitioning to pass/fail grading from tiered grading systems which have been associated with increased competition, grade inflation, decreased wellness, and grading disparities along racial/ethnic lines. This retrospective cohort study followed two cohorts of students from one medical school for four years. One cohort was the last class to enter the school under a 5-point grading system for preclinical courses and the other was the first cohort to enter school under a pass/fail grading system for preclinical courses. Data was collected on various performance measures for the 501 students who comprised these two cohorts. Given the enduring problem of differential attainment between underrepresented in medicine (URiM) students to non-URiM students, we explored whether a change in grading systems impacted all students similarly. Overall students did as well or better in classroom performance, clerkship subject exams, and licensing exams following the change and the effect was essentially equal for URiM and non-URiM students alike. The most important finding was a decrease in differential attainment between URiM and non-URiM students after the change to pass/fail grading for the great majority of the performance measures studied.

Background: Differences exist among doctors in examination performance, clinical and academic career progression, and prevalence of performance assessment by professional regulatory bodies. Some of these differences have been reported in relation to individual characteristics. The purpose of this study is to establish whether any specific individual characteristics are associated with performance in selection for entry into specialty training in Intensive Care in the United Kingdom. Methods: We evaluated data of 509 candidates from the national recruitment rounds of 2018/19 and 2019/20. The outcome evaluated was "success at interview". Variables reaching statistical significance at univariate logistic regression analysis were fed in the multivariable analysis to identify independent predictors of success, with additional exploratory analyses performed, where indicated. Results: The candidates' median age was 31.5 (interquartile range, IQR 30–33.7) years, 324 (63.7%) were male, 256 (50.3%) not married/in civil partnership, 6 (1.2%) pregnant. The majority (316, 62.1%) were White British, 99 (19.5%) of Asian background, other ethnicities represented less than 20% of the sample. Of the 509 candidates, 155 (30.5%) were Atheist, 140 (27.5%) Christian; most were heterosexual (440, 86.4%); 432 (84.9%) reported no disability, while 4 (0.8%) had a minor and 1 (0.2%) had a major disability; 432 (84.9%) candidates held a UK medical degree; 77 (15.1%) a non-UK degree. At univariate logistic regression analysis (LRA) multiple factors were found to be associated with a lower likelihood of success, the strongest being an international medical graduate (IMG, holding a non-UK medical degree); others were increasing age, male gender, being married, Asian or mixed ethnicity, specific religious beliefs (Buddhism, Islam and Hinduism). After feeding all factors significant at univariate analysis, the only two retained as independent predictors at multivariable regression were Asian ethnicity and holding a non-UK degree. Asian UK graduates success rate was 92.7%, comparable to the national average of 92.3%, the Asian IMGs success rate was significantly lower, at 45.5%. Conclusions: As the imbalances seen within the candidates of Asian background are explained by considering the country of primary medical training, the variations in performance is likely to reflect differences in training systems and understanding of the UK NHS. [ABSTRACT FROM AUTHOR]

Racially minoritised doctors make up 45% of the RCOG workforce. Despite a 43% increase in the percentage of racially minoritised doctors joining obstetrics and gynaecology training at ST1 over the last decade in the UK, there is proof that racially minoritised doctors are less likely to pass exams or receive a satisfactory ARCP outcome. Minoritised doctors experience bias, discrimination, and racism throughout their career progression. The cause of differential attainment is multifactorial and requires multifaceted solutions. In addition to reviewing differential attainment, it is equally important to look at the lived experience of racially minoritised doctors. Whilst reading this review, we invite you to reflect on three questions: (1) How can we challenge implicit bias, discrimination and differential sponsorship in obstetrics and gynaecology beyond a mere tick box exercise? (2) What is the impact of raised awareness of differential attainment on the mental health and wellbeing of minoritised doctors? (3) What is the impact of raised awareness of implicit bias, discrimination, and racism on minoritised individuals and the wider workforce? [ABSTRACT FROM AUTHOR]

Introduction: Systematic and structural inequities in power and privilege create differential attainment whereby differences in average levels of performance are observed between students from different socio-demographic groups. This paper reviews the international evidence on differential attainment related to ethnicity/race in medical school, drawing together the key messages from research to date to provide guidance for educators to operationalize and enact change and identify areas for further research. Methods: Authors first identified areas of conceptual importance within differential attainment (learning, assessment, and systems/institutional factors) which were then the focus of a targeted review of the literature on differential attainment related to ethnicity/race in medical education and, where available and relevant, literature from higher education more generally. Each author then conducted a review of the literature and proposed guidelines based on their experience and research literature. The guidelines were iteratively reviewed and refined between all authors until we reached consensus on the Do's, Don'ts and Don't Knows. Results: We present 13 guidelines with a summary of the research evidence for each. Guidelines address assessment practices (assessment design, assessment formats, use of assessments and post-hoc analysis) and educational systems and cultures (student experience, learning environment, faculty diversity and diversity practices). Conclusions: Differential attainment related to ethnicity/race is a complex, systemic problem reflective of unequal norms and practices within broader society and evident throughout assessment practices, the learning environment and student experiences at medical school. Currently, the strongest empirical evidence is around assessment processes themselves. There is emerging evidence of minoritized students facing discrimination and having different learning experiences in medical school, but more studies are needed. There is a pressing need for research on how to effectively redress systemic issues within our medical schools, particularly related to inequity in teaching and learning. [ABSTRACT FROM AUTHOR]

Background: The Covid-19 pandemic had a profound impact on surgical training. In this longitudinal cohort study, we quantify the effects of the pandemic on United Kingdom (UK) surgeons in higher specialty training by analyzing the Annual Review of Competency Progression (ARCP) Outcomes issued to them prior to, and during, the pandemic., Methods: Anonymized records were provided from the UK training management system- the Intercollegiate Surgical Curriculum Programme (ISCP)- on the ARCP Outcomes of higher specialty trainees in General Surgery over the period between January 2017 and December 2022. Demographic data including sex and age group on starting higher specialty training were considered, as were working pattern, phase of training during the height of the pandemic (2020 and 2021), and training region. The proportion of nonstandard outcomes, and the use of specific Covid-19 outcomes, were analyzed to assess the impact of these variables on ARCP outcome using univariate and multivariate logistic regression. Prepandemic outcomes in 2017 were used as a comparator., Results: A total of 7414 ARCP outcomes issued to 1874 General Surgery higher speciality trainees were analysed. The Adjusted Odds Ratio (AOR) for receiving a nonstandard outcome in 2020 (compared to 2017) was 3.07 (95% CI: 2.47-3.81, p < 0.001) not recovering to prepandemic levels by the end of 2022 (AOR 2.11 (95% CI: 1.69-2.64, p < 0.001)). Female sex (AOR 1.27 (95% CI: 1.13-1.43, p < 0.001) and being older on starting higher surgical training (AOR = 1.51 (95% CI: 1.34-1.70, p < 0.001) were both significantly associated with a higher chance of nonstandard outcome. Working pattern was linked to ARCP outcome on univariate analysis, but this relationship disappeared once corrected for other demographic factors (1.05, 95% CI: 0.88-1.24, p = 0.582). Being at a later stage of training during the pandemic was not linked to an increase in AOR of receiving a nonstandard outcome (1.09, 95% CI: 0.97-1.22, p = 0.134), but trainees receiving a nonstandard outcome in this group were more likely to have extra training time advised (15.49%, vs 4.27% in 2021). The highest AOR of receiving a Covid-19 outcome was in the Wessex Deanery at 2.85 (95% CI: 1.83-4.46, p < 0.001), whilst the lowest AOR were seen in Yorkshire and the Humber (0.32, 95% CI: 0.17-0.62, p < 0.001). Removing Covid-19 specific outcomes from the analysis shows a continued rise in the use of nonstandard outcomes in all years except 2020., Conclusions: The Covid-19 Pandemic had a significant impact on the trajectory of training in General Surgery in the UK. Training extensions were more likely to be recommended later in training. There was considerable variation in the use of Covid-19 ARCP outcomes across the UK. There is ongoing evidence of differential attainment at ARCP in General Surgery, with female trainees and older graduates having greater chances of nonstandard outcomes. The underlying reasons for these associations need to be explored. Efforts to urgently address deficits in training post Covid-19 with an awareness of the intersectional nature of differential attainment are needed., (Copyright © 2024 Association of Program Directors in Surgery. Published by Elsevier Inc. All rights reserved.)

Presenting the results from a mixed methods case-study, this paper draws together insight from the fields of ‘BME attainment’ and ‘student transition’ to explore how differential levels of degree attainment might be experienced within the context of a higher tariff university in England. Across a five-year period (2010/11–2014/2015) it compares the levels of degree attainment between UK-domiciled White and Black and Minority Ethnic (BME) students in relation to prior attainment, qualification type, and socioeconomic group (POLAR 3). A range of qualitative data then outlines a series of dynamic factors that can, when compounded, serve to constrain BME students’ capability to negotiate their way through very particular university landscapes. These include: academic expectation and preparedness; the pedagogic terrain; pastoral engagement and sense of belonging finance; and, the lived experience of diversity and ‘othering’. The paper argues that attainment gaps should not be viewed in terms of an individual deficit that needs to be ‘fixed’ or ‘filled’. Instead, greater attention needs to be directed toward enhancing the capacity of higher tariff universities to respond positively to the needs of a changing demographic.

Completion of the Intercollegiate Membership of the Royal College of Surgeons (MRCS) examination is a prerequisite for completion of specialty surgical training in UK. The aim of this study was to compare MRCS performance of OMFS trainees to trainees in other specialities over the past 13 years. Differential attainment (DA) was noted in MRCS Part A (MCQ) pass rates. There was no statistically significant difference in MRCS Part B pass rates. The reasons for this DA are currently unknown and require further investigation. It has been suggested that this may be due at least in part to competing time, family and financial obligations, which increase over time. [ABSTRACT FROM AUTHOR]

Abstract Background Asian medical students and doctors receive lower scores on average than their white counterparts in examinations in the UK and internationally (a phenomenon known as “differential attainment”). This could be due to examiner bias or to social, psychological or cultural influences on learning or performance. We investigated whether students’ scores or feedback show influence of ethnicity-related bias; whether examiners unconsciously bring to mind (activate) stereotypes when judging Asian students’ performance; whether activation depends on the stereotypicality of students’ performances; and whether stereotypes influence examiner memories of performances. Methods This is a randomised, double-blinded, controlled, Internet-based trial. We created near-identical videos of medical student performances on a simulated Objective Structured Clinical Exam using British Asian and white British actors. Examiners were randomly assigned to watch performances from white and Asian students that were either consistent or inconsistent with a previously described stereotype of Asian students’ performance. We compared the two examiner groups in terms of the following: the scores and feedback they gave white and Asian students; how much the Asian stereotype was activated in their minds (response times to Asian-stereotypical vs neutral words in a lexical decision task); and whether the stereotype influenced memories of student performances (recognition rates for real vs invented stereotype-consistent vs stereotype-inconsistent phrases from one of the videos). Results Examiners responded to Asian-stereotypical words (716 ms, 95% confidence interval (CI) 702–731 ms) faster than neutral words (769 ms, 95% CI 753–786 ms, p

Abstract Given our increasingly diverse societies, there is an urgent need for research into the causes of persistent ethnic disparities in undergraduate clinical performance. It is argued that causes for underperformance can be identified from two perspectives, namely that of the students (‘them’) and that of the academic environment (‘us’). Taking the ‘us’ perspective, Yeates et al. conducted a detailed experimental study aimed at understanding the processes underlying judgment and decision-making in clinical assessments. Contrary to their expectations, their study indicates that, despite the presence of active stereotypes, examiner bias does not explain ethnic minority students’ underperformance. Naturally, future studies are required to confirm their findings. It is suggested that these studies should take into account various rater and situational factors (e.g. rater experience, increased cognitive load) that may influence examiners’ reliance on stereotypes. However, future work should also focus on other potential impeding factors from both perspectives, including differences in communication styles. Knowing what leads to the ethnic disparities in performance is a prerequisite for designing interventions aimed at ensuring a level playing field for a diverse student population. Please see related article: https://bmcmedicine.biomedcentral.com/articles/10.1186/s12916-017-0943-0

The Specialised Foundation Programme (SFP), formerly the Academic Foundation Programme, is a highly competitive pathway into academic medicine. There is minimal information available on the demographics of those who apply to the programme, how it scores its applicants and who is successful, making it difficult to assess whether the application process is accessible to all students and promotes a diverse workforce. There are varying levels of support available with coaching, either geographically ring-fenced by universities or available through paid courses. As a result, there is a risk of differential attainment between students who have financial constraints or attend universities where the SFP is less promoted. The aim of the study was to assess student opinion on barriers to the SFP and academic medicine and the demand for the creation of a national, free-to-access SFP mentorship programme to reduce differential attainment amongst student cohorts. Students in the programme received mentorship, peer learning and scheduled teaching events over a six-month period. Surveys were distributed pre- and post-course, and qualitative and quantitative analysis was conducted. Of the respondents, 76% felt that medical schools provided insufficient information on SFP, 31% did not feel financially stable at university and 53% stated that they would not enrol if a cost was present. Applicants were tested on pre- and post-course confidence, all of which showed an increase in mean Likert (1-5) scoring post-mentorship. Financial, institutional and geographical barriers to students applying to the programme were identified. Whilst further research is required to better understand the barriers to academic medicine, national, free-to-access mentorship may effectively reduce differential attainment and improve accessibility amongst students., Competing Interests: The authors have declared that no competing interests exist., (Copyright © 2023, Salem et al.)

Background: Asian medical students and doctors receive lower scores on average than their white counterparts in examinations in the UK and internationally (a phenomenon known as "differential attainment"). This could be due to examiner bias or to social, psychological or cultural influences on learning or performance. We investigated whether students' scores or feedback show influence of ethnicity-related bias; whether examiners unconsciously bring to mind (activate) stereotypes when judging Asian students' performance; whether activation depends on the stereotypicality of students' performances; and whether stereotypes influence examiner memories of performances.Methods: This is a randomised, double-blinded, controlled, Internet-based trial. We created near-identical videos of medical student performances on a simulated Objective Structured Clinical Exam using British Asian and white British actors. Examiners were randomly assigned to watch performances from white and Asian students that were either consistent or inconsistent with a previously described stereotype of Asian students' performance. We compared the two examiner groups in terms of the following: the scores and feedback they gave white and Asian students; how much the Asian stereotype was activated in their minds (response times to Asian-stereotypical vs neutral words in a lexical decision task); and whether the stereotype influenced memories of student performances (recognition rates for real vs invented stereotype-consistent vs stereotype-inconsistent phrases from one of the videos).Results: Examiners responded to Asian-stereotypical words (716 ms, 95% confidence interval (CI) 702-731 ms) faster than neutral words (769 ms, 95% CI 753-786 ms, p < 0.001), suggesting Asian stereotypes were activated (or at least active) in examiners' minds. This occurred regardless of whether examiners observed stereotype-consistent or stereotype-inconsistent performances. Despite this stereotype activation, student ethnicity had no influence on examiners' scores; on the feedback examiners gave; or on examiners' memories for one performance.Conclusions: Examiner bias does not appear to explain the differential attainment of Asian students in UK medical schools. Efforts to ensure equality should focus on social, psychological and cultural factors that may disadvantage learning or performance in Asian and other minority ethnic students. [ABSTRACT FROM AUTHOR]

Background:Following a Judicial review brought by the British Association of Physicians of Indian Origin, greater expectation is now being placed upon Health Education England Local Offices and Deaneries across Scotland, Wales and Northern Ireland to identify doctors who may go on to experience difficulties in general practice specialty training – and who may benefit from educational support at an early stage. NHS Education for Scotland West region has offered an enhanced induction programme for trainees who were identified as being at risk of difficulty in training.Aims:To capture the experience of an enhanced induction programme; exploring insight towards potential difficulties in training; and the feelings relating to being identified as a trainee at risk of difficulty.Method:Interviews with trainees who attended the enhanced induction programme. Transcripts were analysed by a basic thematic analysis approach.Results:All non-UK Doctors completed 17 interviews. The term ‘at risk’ was accepted and the intervention was well received. Participants showed insight into the common areas of difficulty in trainees. The workshops helped to develop understanding of cultural differences, use of the ePortfolio, and gave participants an opportunity to practice their communication skills.Conclusions:This enhanced induction programme has provided targeted training to a group of trainees identified at risk of difficulty. [ABSTRACT FROM AUTHOR]

Background: The unequal distribution of academic and professional outcomes between different minority groups is a pervasive issue in many fields, including surgery. The implications of differential attainment remain significant, not only for the individuals affected but also for the wider health care system. An inclusive health care system is crucial in meeting the needs of an increasingly diverse patient population, thereby leading to better outcomes. One barrier to diversifying the workforce is the differential attainment in educational outcomes between Black and Minority Ethnic (BME) and White medical students and doctors in the United Kingdom. BME trainees are known to have lower performance rates in medical examinations, including undergraduate and postgraduate exams, Annual Review of Competence Progression, as well as training and consultant job applications. Studies have shown that BME candidates have a higher likelihood of failing both parts of the Membership of the Royal Colleges of Surgeons exams and are 10% less likely to be considered suitable for core surgical training. Several contributing factors have been identified; however, there has been limited evidence investigating surgical training experiences and their relationship to differential attainment. To understand the nature of differential attainment in surgery and to develop effective strategies to address it, it is essential to examine the underlying causes and contributing factors. The Variation in Experiences and Attainment in Surgery Between Ethnicities of UK Medical Students and Doctors (ATTAIN) study aims to describe and compare the factors and outcomes of attainment between different ethnicities of doctors and medical students., Objective: The primary aim will be to compare the effect of experiences and perceptions of surgical education of students and doctors of different ethnicities., Methods: This protocol describes a nationwide cross-sectional study of medical students and nonconsultant grade doctors in the United Kingdom. Participants will complete a web-based questionnaire collecting data on experiences and perceptions of surgical placements as well as self-reported academic attainment data. A comprehensive data collection strategy will be used to collect a representative sample of the population. A set of surrogate markers relevant to surgical training will be used to establish a primary outcome to determine variations in attainment. Regression analyses will be used to identify potential causes for the variation in attainment., Results: Data collected between February 2022 and September 2022 yielded 1603 respondents. Data analysis is yet to be competed. The protocol was approved by the University College London Research Ethics Committee on September 16, 2021 (ethics approval reference 19071/004). The findings will be disseminated through peer-reviewed publications and conference presentations., Conclusions: Drawing upon the conclusions of this study, we aim to make recommendations on educational policy reforms. Additionally, the creation of a large, comprehensive data set can be used for further research., International Registered Report Identifier (irrid): DERR1-10.2196/40545., (©Samar Babiker, Innocent Ogunmwonyi, Maria W Georgi, Lawrence Tan, Sharmi Haque, William Mullins, Prisca Singh, Nadya Ang, Howell Fu, Krunal Patel, Jevan Khera, Monty Fricker, Simon Fleming, Lolade Giwa-Brown, Peter A Brennan, Ekpemi Irune, Stella Vig, Arjun Nathan. Originally published in JMIR Research Protocols (https://www.researchprotocols.org), 16.06.2023.)

Background: International Medical Graduates (IMGs) are known to perform less well in many postgraduate medical examinations when compared to their UK trained counterparts. This "differential attainment" is observed in both knowledge-based and clinical skills assessments. This study explored the influence of culture and language on IMGs clinical communication skills, in particular, their ability to seek, detect and acknowledge patients' concerns in a high stakes postgraduate clinical skills examination. Hofstede's cultural dimensions framework was used to look at the impact of culture on examination performance. Methods: This was a qualitative, interpretative study using thematic content analysis of video-recorded doctor-simulated patient consultations of candidates sitting the MRCP(UK) PACES examination, at a single examination centre in November 2012. The research utilised Hofstede's cultural dimension theory, a framework for comparing cultural factors amongst different nations, to help understand the reasons for failure. Results: Five key themes accounted for the majority of communication failures in station 2, "history taking" and station 4, "communication skills and ethics" of the MRCP(UK) PACES examination. Two themes, the ability to detect clues and the ability to address concerns, related directly to the overall construct managing patients' concerns. Three other themes were found to impact the whole consultation. These were building relationships, providing structure and explanation and planning. Conclusion: Hofstede's cultural dimensions may help to contextualise some of these observations. In some cultures doctor and patient roles are relatively inflexible: the doctor may convey less information to the patient (higher power distance societies) and give less attention to building rapport (high uncertainty avoidance societies.) This may explain why cues and concerns presented by patients were overlooked in this setting. Understanding cultural differences through Hofstede's cultural dimensions theory can inform the preparation of candidates for high stakes bedside clinical skills examinations and for professional practice. [ABSTRACT FROM AUTHOR]

Background: International medical graduates (IMGs) are known to have significantly lower first attempt pass rates at the clinical skills assessment examination (CSA) than UK graduates. Whilst much has been published concerning higher fail rates in this group, there has been very little exploration of factors associated with success. Aims: This research aims to identify and explore factors associated with success in the CSA. Method: Telephone interviews with 10 IMGs who had passed the CSA on their first attempt were undertaken. Participants were current or recent (previous academic year) GP trainees in Scotland. Transcripts of the interviews were analysed by a thematic analysis approach. Results: Six main themes emerged from the data analysis. These were insights into the challenges, a proactive approach, refining consultation skills, learning with UK graduates, valuing feedback and supportive relationships. Conclusions: This research adds the much-needed voice and experience of IMGs to a current area of uncertainty and challenge in medical education. It provides some insights into potential solutions to the issues and will be of interest to both trainees and those involved in their education. [ABSTRACT FROM AUTHOR]

Given our increasingly diverse societies, there is an urgent need for research into the causes of persistent ethnic disparities in undergraduate clinical performance. It is argued that causes for underperformance can be identified from two perspectives, namely that of the students ('them') and that of the academic environment ('us'). Taking the 'us' perspective, Yeates et al. conducted a detailed experimental study aimed at understanding the processes underlying judgment and decision-making in clinical assessments. Contrary to their expectations, their study indicates that, despite the presence of active stereotypes, examiner bias does not explain ethnic minority students' underperformance. Naturally, future studies are required to confirm their findings. It is suggested that these studies should take into account various rater and situational factors (e.g. rater experience, increased cognitive load) that may influence examiners' reliance on stereotypes. However, future work should also focus on other potential impeding factors from both perspectives, including differences in communication styles. Knowing what leads to the ethnic disparities in performance is a prerequisite for designing interventions aimed at ensuring a level playing field for a diverse student population.Please see related article: https://bmcmedicine.biomedcentral.com/articles/10.1186/s12916-017-0943-0. [ABSTRACT FROM AUTHOR]

Competing Interests: Anjali Menezes: Co-authored and received payment for a faculty development workshop on supporting racialised medical learners at the Canadian Conference of Medical Education in April 2022. Shayna Henry: Co-authored and received payment for a faculty development workshop on supporting racialised medical learners at the Canadian Conference of Medical Education in April 2022. Gina Agarwal: None.

This paper is a response to the recent NZJES article by Snook and O'Neill on social class and educational achievement. It is not a critique of their position but rather uses their analysis as a springboard to offer a way forward on some of the key issues they address. The discussion proceeds through three stages: first, the widely accepted dualism of internal school causes and external social causes is rejected in favour of a causal system of proximal and distal causes; second, a case is made for the search for a causal mechanism located in neural operations causally connected to anterior and posterior factors; third, antecedent causes are briefly considered, with a final comment on a way forward. [ABSTRACT FROM AUTHOR]

Objectives: International medical graduates (IMGs) perform less well in national postgraduate licensing examinations compared with UK graduates, even in computer-marked multiple-choice licensing examinations. We aimed to investigate thought processes of candidates answering multiple- choice questions, considering possible reasons for differential attainment between IMGs and UK graduates., Design: We employed a semistructured qualitative design using cognitive interviews. Systematic grounded theory was used to analyse data from 'think aloud' interviews of general practitioner specialty trainees (GPSTs) while answering up to 15 live questions from the UK Membership of the Royal College of General Practitioners Applied Knowledge Test (AKT)., Setting: East Midlands, UK., Participants: 21 GPSTs including 13IMGs and 8 UK-trained doctors., Outcomes: Perceptions of participants on how they answered AKT questions together with strategies used or difficulties experienced., Results: We interviewed 21 GPSTs (8 female, 13 male, 13 IMGs, 14 from black and minority ethnic groups, age 24-64 years) in years 1-3 of training between January and April 2017. Four themes were identified. 'Theoretical versus real-life clinical experience': participants reported difficulties recalling information and responding to questions from theoretical learning compared with clinical exposure; rote learning helped some IMGs recall rare disease patterns. Recency, frequency, opportunity and relevance: participants reported greater difficulty answering questions not recently studied, less frequently encountered or perceived as less relevant. Competence versus insight: some participants were over optimistic about their performance despite answering incorrectly. Cultural barriers: for IMGs included differences in undergraduate experience, lack of familiarity with UK guidelines and language barriers which overlapped with the other themes., Conclusions: The difficulties we identified in candidates when answering AKT questions may be addressed through training. IMGs face additional difficulties which impede examination success due to differences in educational experience, content familiarity and language, which are also potentially amenable to additional training support., Competing Interests: Competing interests: AS is research and development lead for assessment for the MRCGP examination and CB is a previous lead and current member of the MRCGP AKT Core Group., (© Author(s) (or their employer(s)) 2019. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.)

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., Competing Interests: 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., (© Article author(s) (or their employer(s) unless otherwise stated in the text of the article) 2018. All rights reserved. No commercial use is permitted unless otherwise expressly granted.)

Introduction: We explored effects of gender, ethnic origin, first language, and training status on scores in the Intercollegiate Specialty Board examinations in the UK and Ireland across the computer-marked written section and in the face-to-face oral and clinical section., Methods: Demographic characteristics and examination results from 9987 attempts across 177 sittings from 2009 to 2013 were analyzed in an analysis of variance by training status, gender, ethnic origin, first language, and section (computer-marked multiple-choice examination vs face-to-face oral and clinical examination)., Results: We found increasing alignment between examiner and candidate characteristics during this period, with a 50% increase in examiners of Asian ethnic origin and a 60% increase in examiners whose first language is not English. The strongest factor in the analysis of variance was training status (F[2, 9818] = 27.67, p < 0.001), with candidates in training significantly outperforming others. Within "core candidates" (first attempt, in training), we found significant main effects for ethnic origin (F[5, 4809] = 2.36, p = 0.04), and first language (F[2, 4809] = 5.29, p = 0.003), but no interaction effects between these factors and section (both F < 1, p > 0.05)., Conclusions: Training status was the most important factor in candidates' results. Although the analysis showed significant effects of ethnic origin and first language within "core candidates," these differences were statistically indistinguishable between the 2 sections of the examination, suggesting that the differential attainment by these factors cannot be attributed to examiner bias in a face-to-face examination., (Copyright © 2015 Association of Program Directors in Surgery. Published by Elsevier Inc. All rights reserved.)