Tackling disadvantage in medical education

On 2 March the General Medical Council (GMC) published a report of the latest data on the progression of doctors in postgraduate medical training across the UK. We welcome the report, which provides more detail than in previous years and gives valuable insights into outcomes and experiences of doctors from different backgrounds.

The data show persistent inequalities, particularly in relation to poorer outcomes for UK graduates of Black or Black British heritage, who, on average, are less likely to receive an offer when applying for specialty training than other UK-qualified groups and to have lower pass rates in specialty exams. The report also shows significant inequalities for doctors from other ethnic minority groups, Muslim doctors, disabled doctors, and those from a lower socioeconomic background.

The report makes for sobering reading, and we understand why many members, particularly those who can personally identify with the inequalities detailed, may find it upsetting and frustrating.

It is of particular concern that no progress has been made in reducing the attainment gap between doctors of different ethnicities. It is clear that all of us working in medical education need to take action to change this, and to address other persistent inequalities that are having a detrimental impact on individual doctors and the profession as a whole.

At the College, we are committed to supporting our fellows, members and staff from Black, Asian and Minority Ethnic communities and to addressing inequalities within our specialty. Our Equality, Diversity and Inclusion Committee leads our work in this area, aligned to our core value of justice and fairness. We support the GMC’s commitment to play an active role in tackling inequalities by setting a target to eliminate the disadvantage and discrimination in education and training faced by ethnic minority doctors and international medical graduates (IMGs).

We are in the process of implementing our differential attainment action plan, which sets out what we are doing to improve outcomes, as well as the recommendations from an independent review of the College’s assessment processes. The actions we are taking arising from both of these important pieces of work include:  

• Undertaking new research to investigate the impact of gender, ethnicity and education background on exam performance. This will provide a better understanding of the factors affecting differential attainment in anaesthesia.

• Further increasing diversity among our examiners. We are committed to ensuring our examiner pool is representative and inclusive. The independent review concluded that we have made some good progress in this area, and we will continue to make it a priority. We ensure that all our examiners undertake examination-specific diversity training, including in recognising unconscious bias.

• Developing our online training hub to make training guidance easily accessible to all and providing training and exam preparation materials for candidates. We also provide training and support for our College Tutors on the attainment gap and other relevant issues.

• Reviewing and improving our process for responding to requests for reasonable adjustments from examination candidates.

• Learning from emerging best practice established by other organisations within medical education, for example those that are identified in the GMC report.

More broadly, across the College we are also working to improve our understanding of the needs of our members and the opportunities to support them, and to widen participation in the specialty of anaesthesia. For example:  

• We have established an Equality Research Project to investigate issues relating to equality, diversity, inclusion and representation within the specialty and the structure of the College. This includes enhancing our systems for collecting data about our membership so that we can improve understanding of inequalities in our specialty and its leadership positions. As a member of the College, you can help us by updating your information in MyRCoA so that we can assess diversity trends within our membership.

• We are working in partnership with the Widening Participation Medics Network to establish a mentoring scheme (GasReach) for final year medical students and foundation doctors from underrepresented groups to access a career in anaesthesia.

• We run New to the NHS meetings for doctors newly-arrived in the UK and for doctors on the Medical Training Initiative (MTI). We are also working with the Association of Anaesthetists and the Royal Society of Medicine to deliver a conference to be held at the GMC in September 2023, with an equality, diversity and inclusion theme. We will update members when more information is available on the programme and how to register.   

We recognise that reducing inequalities within our specialty and the wider profession is a long-term challenge. But we want to assure members that our focus on advocating for, and delivering, equality, diversity and inclusion within the College and the specialty of anaesthesia is fundamentally important to us.

Dr Elisa Bertoja, Chair, Equality, Diversity and Inclusion Committee
Dr Fiona Donald, President