Vol. 14 No. 1 (2021): Year of the Nurse
Articles

A Review of Differential Attainment in Recruitment in the UK Medical Profession: Bridging the Gap - Thematic series on Tackling Differential Attainment in Medical Profession 20-21

Jyothi Srinivas
Miton Keynes University Hospital, Milton Keynes, UK
Bio
Akhila Panda
University of Buckingham Medical School, UK
Bio
Alison Ferguson
University of Buckingham Medical School, UK
Bio
Saman Zaman
St Georges University Hospitals Foundation Trust, London, UK
Bio
Shevonne Matheiken MRCPsych 
Northamptonshire NHS Foundation Trust, Northampton, UK
Bio
Sarthak Bahl
Bio
Umakanth R Kempanna
Hull University Teaching Hospitals NHS Trust, Hull, UK
Bio
Faisal Hasan MD MRCP
Royal United Hospital, Bath, UK
Bio
Veeresh Patil
Miton Keynes University Hospital, Milton Keynes, UK
Indranil Chakravorty MBBS PhD FRCP
St Georges University Hospitals Foundation Trust, London, UK
Bio
capt Tom Moore by Aria

Published 2021-02-08

Keywords

  • differential attainment,
  • medical professions,
  • Bridging the Gap,
  • BME

How to Cite

Srinivas, J., Panda, A., Ferguson, A., Zaman, S., Matheiken, S., Bahl, S., Kempanna, U. R., Hasan, F., Patil, V., & Chakravorty, I. (2021). A Review of Differential Attainment in Recruitment in the UK Medical Profession: Bridging the Gap - Thematic series on Tackling Differential Attainment in Medical Profession 20-21. Sushruta Journal of Health Policy & Opinion, 14(1), 1–15. https://doi.org/10.38192/14.1.12

Abstract

Differential attainment is the phenomenon where groups of people, in this case, members of the medical profession, experience differences in their achievement based on factors which are beyond their control. There are multiple contributory factors including gender, age, race, ethnicity, socio-economic and disability. The evidence suggests that medical professionals from Black and minority ethnic backgrounds, women, those with a disability, international medical graduates, those from low socioeconomic status and from geographical low participation (in higher education) areas tend to find barriers in every stage of recruitment to medical schools and later during their careers. There is emerging data over the last 5 years (post-2014) of organisations such as General Medical Council, Medical Schools Council and members of the Academy of Royal Colleges that are striving to offer transparency and annual reports which offer the opportunity for reflection and self-assessment.

 

The British Association of Physicians of Indian Origin has been leading a collaborative initiative with the ‘Alliance for Equality in Healthcare Professions’ to tackle the full range of differential attainment. This collaboration brings multiple stakeholder organisations and grassroots bodies around the table with international experts in reviewing the evidence, the data from focus groups and working to develop tangible, SMART interventions to address these disparities. This review on DA in recruitment is one of six such themes which will constitute the ‘Bridging the Gap’ report due in line with the Silver Jubilee celebrations of BAPIO in September 2021. The report will present evidence-based, consensus on recommendations for action at national, regional and local level and areas for further collaborative research.

References

  1. General Medical Council (Great Britain). The state of medical education and practice in the UK, 2014. [Internet]. 2014 [cited 2020 Aug 1]. Available from: http://www.gmc-uk.org/SOMEP_2014_FINAL.pdf_58751753.pdf
  2. Protocol for Thematic Synthesis of Differential Attainment in the Medical Profession - ‘Bridging the Gap’ Series | Sushruta Journal of Health Policy & Opinion [Internet]. [cited 2020 Oct 31]. Available from: https://www.sushrutajnl.net/index.php/sushruta/article/view/91
  3. NHS workforce [Internet]. [cited 2020 Jul 8]. Available from: https://www.ethnicity-facts-figures.service.gov.uk/workforce-and-business/workforce-diversity/nhs-workforce/latest#by-ethnicity-and-grade-medical-staff
  4. Ethnicity-in-the-NHS-infographic.pdf [Internet]. [cited 2021 Jan 26]. Available from: https://www.nhsemployers.org/-/media/Employers/Documents/Plan/DIVERSITY-AND-INCLUSION/EQW19/Ethnicity-in-the-NHS-infographic.pdf
  5. equality-analysis-wres-april-16.pdf [Internet]. [cited 2021 Jan 26]. Available from: https://www.england.nhs.uk/wp-content/uploads/2014/10/equality-analysis-wres-april-16.pdf
  6. Diversity within diversity: the NHS workforce from overseas [Internet]. The Nuffield Trust. 2018 [cited 2021 Jan 26]. Available from: https://www.nuffieldtrust.org.uk/news-item/diversity-within-diversity-the-nhs-workforce
  7. Kline R. The snowy white peaks of the NHS: a survey of discrimination in governance and leadership and the potential impact on patient care in London and England [Internet]. London: Middlesex University; 2014 [cited 2020 Oct 23]. Available from: https://doi.org/10.22023/mdx.12640421.v1
  8. New data on gender pay gap in medicine [Internet]. GOV.UK. [cited 2020 Aug 31]. Available from: https://www.gov.uk/government/news/new-data-on-gender-pay-gap-in-medicine
  9. The NHS Constitution for England [Internet]. GOV.UK. [cited 2020 Aug 31]. Available from: https://www.gov.uk/government/publications/the-nhs-constitution-for-england/the-nhs-constitution-for-england
  10. Progression reports [Internet]. [cited 2021 Jan 26]. Available from: https://www.gmc-uk.org/education/reports-and-reviews/progression-reports
  11. Woolf K. Fair Training Pathways for All: Understanding Experiences of Progression - Final Report. :69.
  12. links-between-nhs-staff-experience-and-patient-satisfaction-1.pdf [Internet]. [cited 2021 Jan 26]. Available from: https://www.england.nhs.uk/wp-content/uploads/2018/02/links-between-nhs-staff-experience-and-patient-satisfaction-1.pdf
  13. Diversity should be a strategic priority | The King’s Fund [Internet]. [cited 2021 Jan 26]. Available from: https://www.kingsfund.org.uk/blog/2018/08/diversity-should-be-strategic-priority
  14. selecting-for-excellence-final-report.pdf [Internet]. [cited 2021 Jan 26]. Available from: https://www.medschools.ac.uk/media/1203/selecting-for-excellence-final-report.pdf
  15. Research report on population estimates by ethnic group and religion - Office for National Statistics [Internet]. [cited 2021 Jan 1]. Available from: https://www.ons.gov.uk/peoplepopulationandcommunity/populationandmigration/populationestimates/articles/researchreportonpopulationestimatesbyethnicgroupandreligion/2019-12-04
  16. Mathers J, Sitch A, Marsh JL, Parry J. Widening access to medical education for under-represented socioeconomic groups: population based cross sectional analysis of UK data, 2002-6. BMJ. 2011 Feb 22;342:d918.
  17. McManus I, Woolf K, Dacre J. The educational background and qualifications of UK medical students from ethnic minorities. BMC Med Educ. 2008 Apr 16;8(1):21.
  18. Steven K, Dowell J, Jackson C, Guthrie B. Fair access to medicine? Retrospective analysis of UK medical schools application data 2009-2012 using three measures of socioeconomic status. BMC Med Educ. 2016 Jan 13;16(1):11.
  19. Lewington K. Changes to medical education over the past 20 years. BMJ. 2012 Jun 29;344:e4246.
  20. Higher Education Student Statistics: UK, 2018/19 - Student numbers and characteristics | HESA [Internet]. [cited 2021 Jan 1]. Available from: https://www.hesa.ac.uk/news/16-01-2020/sb255-higher-education-student-statistics/numbers
  21. Medical workforce [Internet]. The King’s Fund. [cited 2021 Jan 1]. Available from: https://www.kingsfund.org.uk/projects/time-think-differently/trends-workforce-medical
  22. Shrewsbury D, Mogensen L, Hu W. Problematizing medical students with disabilities: A critical policy analysis. MedEdPublish [Internet]. 2018 Feb 26 [cited 2021 Jan 1];7. Available from: https://www.mededpublish.org/manuscripts/1463
  23. Oracle BI Interactive Dashboards - NTS [Internet]. [cited 2021 Jan 1]. Available from: https://webcache.gmc-uk.org/analyticsrep/saw.dll?Dashboard&PortalPath=%2fshared%2fNTS_LTD%2f_portal%2fNTS&Page=Recruitment%20(postgraduate)&Done=Dashboard%26PortalPath%3d%252fshared%252fNTS_LTD%252f_portal%252fNTS%26Page%3dMain%2520Menu%26ViewState%3dp8ggk68eemgg5jf1rc3m2uu28a
  24. Survey of specialty and associate specialist (SAS) and locally employed (LE) doctors [Internet]. [cited 2021 Jan 1]. Available from: https://www.gmc-uk.org/education/standards-guidance-and-curricula/projects/survey-of-specialty-and-associate-specialist-and-locally-employed-doctors
  25. SAS doctors’ perceptions of their role in the NHS | The BMJ [Internet]. [cited 2021 Jan 1]. Available from: https://www.bmj.com/content/344/bmj.e2819.full
  26. SAS survey report published [Internet]. [cited 2021 Jan 1]. Available from: http://www.nhsemployers.org/news/2020/07/specialty and associate specialist doctor survey report published
  27. Oroz C, Sands LR, Lee J. SAS doctors career progression survey 2013. Int J STD AIDS. 2016 Mar 1;27(3):231–4.
  28. Claxton N, Griffin L. A forgotten tribe: a survey of the experience of working as a non-consultant career grade psychiatrist. Psychiatr Bull. 2006 Oct;30(10):369–72.
  29. Fletcher E, Abel GA, Anderson R, Richards SH, Salisbury C, Dean SG, et al. Quitting patient care and career break intentions among general practitioners in South West England: findings of a census survey of general practitioners. BMJ Open. 2017 Apr 1;7(4):e015853.
  30. Barber S, Brettell R, Perera-Salazar R, Greenhalgh T, Harrington R. UK medical students’ attitudes towards their future careers and general practice: a cross-sectional survey and qualitative analysis of an Oxford cohort. BMC Med Educ. 2018 Jul 4;18(1):160.
  31. Equalities_Impact_Report.pdf [Internet]. [cited 2021 Jan 29]. Available from: https://gprecruitment.hee.nhs.uk/Portals/8/Documents/Equality%20Diversity/Equalities_Impact_Report.pdf
  32. Allen T, Walshe K, Proudlove N, Sutton M. Using quality indicators to predict inspection ratings: cross-sectional study of general practices in England. Br J Gen Pract J R Coll Gen Pract. 2020 Jan;70(690):e55–63.
  33. GP performance reviews will be part-anonymised to ‘tackle bias’ - [Internet]. Management In Practice. 2020 [cited 2021 Jan 2]. Available from: https://managementinpractice.com/your-practice/cqc/gp-performance-reviews-will-be-part-anonymised-to-tackle-bias/
  34. fair-to-refer-report-pdf-79011677_pdf-79021583.pdf [Internet]. [cited 2020 Oct 23]. Available from: https://www.gmc-uk.org/-/media/documents/fair-to-refer-report-pdf-79011677_pdf-79021583.pdf
  35. GMC more likely to investigate complaints against BME doctors [Internet]. Pulse Today. 2019 [cited 2021 Jan 2]. Available from: https://www.pulsetoday.co.uk/news/regulation/gmc-more-likely-to-investigate-complaints-against-bme-doctors/
  36. Simpson J, Waddington K. Migrant Architects of the NHS: South Asian Doctors and the Reinvention of British General Practice. Manchester University Press; 2020. 336 p.
  37. NHS Workforce Statistics - September 2019 [Internet]. NHS Digital. [cited 2020 Sep 1]. Available from: https://digital.nhs.uk/data-and-information/publications/statistical/nhs-workforce-statistics/september-2019
  38. Milner A, Baker E, Jeraj S, Butt J. Race-ethnic and gender differences in representation within the English National Health Service: a quantitative analysis. BMJ Open. 2020 14;10(2):e034258.
  39. Richardson JTE. The attainment of ethnic minority students in UK higher education. Stud High Educ. 2008 Feb 1;33(1):33–48.
  40. Connor H, Tyers C, Modood T. Why the Difference? A Closer Look at Higher Education Minority Ethnic Students and Graduates. Res Rep. 2004 Jan 1;552.
  41. Alers M, van Leerdam L, Dielissen P, Lagro-Janssen A. Gendered specialities during medical education: a literature review. Perspect Med Educ. 2014 Jun;3(3):163–78.
  42. Pelaccia T, Delplanq H, Triby E, Bartier J-C, Leman C, Hadef H, et al. Gender Stereotypes: An Explanation to the Underrepresentation of Women in Emergency Medicine. Acad Emerg Med. 2010;17(7):775–9.
  43. Woolf K, Potts HWW, McManus IC. Ethnicity and academic performance in UK trained doctors and medical students: systematic review and meta-analysis. BMJ. 2011 Mar 8;342:d901.
  44. McManus IC, Elder AT, Dacre J. Investigating possible ethnicity and sex bias in clinical examiners: an analysis of data from the MRCP(UK) PACES and nPACES examinations. BMC Med Educ [Internet]. 2013 Jul 30 [cited 2020 Jul 8];13. Available from: http://dx.doi.org/10.1186/1472-6920-13-103
  45. Halford S. Racism In the Medical Profession: the Experience of UK Graduates. [cited 2021 Feb 8]; Available from: https://www.academia.edu/457985/Racism_In_the_Medical_Profession_the_Experience_of_UK_Graduates
  46. Jones L, Halford S, Leonard P. Racism in the medical profession: the experience of UK graduates. 2003.
  47. Limb M. NHS doctors face racism, exclusion, and discrimination, report finds. BMJ. 2014 Jul 31;349:g4960.
  48. Mathew R. Rammya Mathew: Racism in medicine—migrant doctors aren’t here just to “fill a gap”. BMJ. 2020 Feb 12;368:m483.
  49. Racism in the NHS: don’t let the unspeakable become acceptable [Internet]. openDemocracy. [cited 2020 May 23]. Available from: https://www.opendemocracy.net/en/ournhs/racism-in-nhs-don-t-let-unspeakable-become-acceptable/
  50. The interacting dynamics of institutional racism in higher education: Race Ethnicity and Education: Vol 16, No 2 [Internet]. [cited 2020 Oct 23]. Available from: https://www.tandfonline.com/doi/abs/10.1080/13613324.2011.646255
  51. Burke BP, White JC. The well-being of gay, lesbian, and bisexual physicians. West J Med. 2001 Jan;174(1):59–62.
  52. Burke BP, Saunders D, White JC. Wellbeing of gay, lesbian, and bisexual doctorsCommentary: The medical profession should face up to its own homophobia. BMJ. 2001 Feb 17;322(7283):422–5.
  53. Homophobia among doctors | The BMJ [Internet]. [cited 2021 Jan 29]. Available from: https://www.bmj.com/content/308/6928/586
  54. Risdon C, Cook D, Willms D. Gay and lesbian physicians in training: a qualitative study. CMAJ Can Med Assoc J. 2000 Feb 8;162(3):331–4.
  55. Smith F, Goldacre MJ, Lambert TW. Working as a doctor when chronically ill or disabled: comments made by doctors responding to UK surveys. JRSM Open. 2016 Jul;7(7):2054270416649282.
  56. Disability in the medical profession [Internet]. The British Medical Association is the trade union and professional body for doctors in the UK. [cited 2021 Jan 29]. Available from: https://www.bma.org.uk/advice-and-support/nhs-delivery-and-workforce/workforce/disability-in-the-medical-profession
  57. The Boar [Internet]. [cited 2021 Jan 29]. Available from: https://theboar.org/2019/03/medical-schools-diversity/
  58. Gishen F, Lokugamage A. Diversifying the medical curriculum. BMJ. 2019 Jan 23;364:l300.
  59. Spooner S, Pearson E, Gibson J, Checkland K. How do workplaces, working practices and colleagues affect UK doctors’ career decisions? A qualitative study of junior doctors’ career decision making in the UK. BMJ Open. 2017 Oct;7(10):e018462.
  60. Plan NLT. NHS Long Term Plan [Internet]. NHS Long Term Plan. [cited 2021 Feb 3]. Available from: https://www.longtermplan.nhs.uk
  61. NHS England » We are the NHS: People Plan for 2020/2021 – action for us all [Internet]. [cited 2020 Sep 28]. Available from: https://www.england.nhs.uk/ournhspeople/
  62. NHS England » Our NHS People Promise [Internet]. [cited 2021 Feb 3]. Available from: https://www.england.nhs.uk/ournhspeople/online-version/lfaop/our-nhs-people-promise/
  63. Travers J, Smaldone A, Gross Cohn E. Does State Legislation Improve Nursing Workforce Diversity? Policy Polit Nurs Pract. 2015 Aug 1;16(3–4):109–16.
  64. Fuller SS, Bridgman CM. A scheme to recruit Pakistani and Bangladeshi trainee dental nurses in a multiethnic area of Greater Manchester. Br Dent J. 2004 Aug;197(4):185–7.
  65. Gilliss CL, Powell DL, Carter B. Recruiting and Retaining a Diverse Workforce in Nursing: From Evidence to Best Practices to Policy. Policy Polit Nurs Pract. 2010 Nov 1;11(4):294–301.
  66. Shaw Q. High failure rate of ethnic minority groups in MRCGP exam comes from changes to exam and candidate selection. BMJ. 2013 Oct 29;347:f6442.
  67. Deas D, Pisano ED, Mainous AGI, Johnson NG, Singleton MH, Gordon L, et al. Improving Diversity Through Strategic Planning: A 10-Year (2002–2012) Experience at the Medical University of South Carolina. Acad Med. 2012 Nov;87(11):1548–55.
  68. Vick AD, Baugh A, Lambert J, Vanderbilt AA, Ingram E, Garcia R, et al. Levers of change: a review of contemporary interventions to enhance diversity in medical schools in the USA. Adv Med Educ Pract. 2018;9:53–61.
  69. Frusti DK, Niesen KM, Campion JK. Creating a culturally competent organization: use of the diversity competency model. J Nurs Adm. 2003 Jan;33(1):31–8.
  70. Geary A, Wang V, Cooper J, Roberts K, Yoo J. Analysis of Electronic Residency Application Service (ERAS) Data Can Improve House Staff Diversity. J Surg Res. 2021 Jan 1;257:246–51.
  71. Jalal M, Bardhan KD, Sanders D, Illing J. INTERNATIONAL: Overseas doctors of the NHS: migration, transition, challenges and towards resolution. Future Healthc J. 2019 Feb;6(1):76–81.
  72. Health Disparities: State Laws [Internet]. [cited 2021 Feb 8]. Available from: https://www.ncsl.org/research/health/health-disparities-laws.aspx
  73. Gardner JD. A successful Minority Retention Project. J Nurs Educ. 2005 Dec;44(12):566–8.
  74. Whitman MV, Valpuesta D. Examining Human Resources’ Efforts to Develop a Culturally Competent Workforce. Health Care Manag. 2010 Jun;29(2):117–25.
  75. Weech-Maldonado R, Dreachslin JL, Dansky KH, De Souza G, Gatto M. Racial/ethnic diversity management and cultural competency: the case of Pennsylvania hospitals. J Healthc Manag Am Coll Healthc Exec. 2002 Apr;47(2):111–24; discussion 124-126.
  76. Dreaschlin J. Diversity Leadership. Chicago, IL: Health Administration Press; 1996.
  77. Schuster MA, Conwell WD, Connelly MT, Humphrey HJ. Building Equity, Inclusion, and Diversity Into the Fabric of a New Medical School: Early Experiences of the Kaiser Permanente Bernard J. Tyson School of Medicine. Acad Med J Assoc Am Med Coll. 2020 Dec;95(12S Addressing Harmful Bias and Eliminating Discrimination in Health Professions Learning Environments):S66–70.
  78. Yu PT, Parsa PV, Hassanein O, Rogers SO, Chang DC. Minorities struggle to advance in academic medicine: A 12-y review of diversity at the highest levels of America’s teaching institutions. J Surg Res. 2013 Jun 15;182(2):212–8.
  79. Is your hospital culturally competent? (And what does that mean exactly?) - PubMed [Internet]. [cited 2021 Feb 8]. Available from: https://pubmed.ncbi.nlm.nih.gov/15926357/
  80. Mmeje O, Price EAN, Johnson TRB, Fenner DE. Galvanizing for the future: a bottom-up departmental approach to diversity, equity, and inclusion. Am J Obstet Gynecol. 2020 Nov 1;223(5):715.e1-715.e7.
  81. Spottswood SE, Spalluto LB, Washington ER, Donnelly EF, Birch AA, Bradshaw ML, et al. Design, Implementation, and Evaluation of a Diversity Program for Radiology. J Am Coll Radiol. 2019 Jul 1;16(7):983–91.
  82. Aneez Esmail and Sam Everington: The perils of researching racial discrimination [Internet]. The BMJ. 2020 [cited 2020 May 23]. Available from: https://blogs.bmj.com/bmj/2020/02/13/aneez-esmail-and-sam-everington-the-perils-of-researching-racial-discrimination/
  83. Plint S, Patterson F. Identifying critical success factors for designing selection processes into postgraduate specialty training: the case of UK general practice. Postgrad Med J. 2010 Jun 1;86(1016):323–7.
  84. Sunago M. Strategies for Nursing Leaders on Recruiting and Retaining a Diverse Workforce. Creat Nurs. 2020 Feb 1;26(1):17–22.
  85. Sokal-Gutierrez K, Ivey SL, Garcia RM, Azzam A. Evaluation of the Program in Medical Education for the Urban Underserved (PRIME-US) at the UC Berkeley-UCSF Joint Medical Program (JMP): The First 4 Years. Teach Learn Med. 2015;27(2):189–96.
  86. Escallier LA, Fullerton JT. Process and outcomes evaluation of retention strategies within a nursing workforce diversity project. J Nurs Educ. 2009 Sep;48(9):488–94.
  87. Kehoe A, McLachlan J, Metcalf J, Forrest S, Carter M, Illing J. Supporting international medical graduates’ transition to their host‐country: realist synthesis. Med Educ. 2016 Oct;50(10):1015–32.
  88. Beacham T, Askew RW, William PR. Strategies to increase racial/ethnic student participation in the nursing profession. ABNF J Off J Assoc Black Nurs Fac High Educ Inc. 2009;20(3):69–72.