Working with doctors Working for patients

Working together to better support doctors in training

We are working with education and training organisations across the UK to understand doctors’ progression through the training programmes that we approve. This has involved collecting and publishing a range of outcome data, which can be found here. We are also working with others to better understand this data to explore the variation in performance and attainment for individuals who share protected characteristics (also referred to as differential attainment).

We are exploring interventions and examples of good practice which are taking place to support trainees who may face barriers throughout training programmes, the intention better understand the evaluation of these initiatives.

We are committed to ensuring that training pathways are fair for all and have a focussed work programme to investigate, understand and take action where we find evidence of unfairness or unsupportive environments. Our aim is to ensure that the framework for education and training promotes fairness and safeguards against any potential bias or discrimination.

There are three themes to this work:

  • Using our standards and quality assurance framework to drive change.
  • Working with others to understand the issues, to take action and to share knowledge and practice.
  • Using data and evidence to measuring and monitor progress.

We will use these pages to share regular updates about our work. You can find more detailed information and links to all the published research below.

May 2017- new research findings

Further research into Fair Training Pathways for all: Understanding experiences of progression

We've published the second phase of research commissioned from the Research Department of Medical Education (RDME) at University College London (UCL).

Part one of the research, published in July 2016, explores the progression and personal training experiences of a range of doctors – and whether this differs depending on their place of primary medical qualification and/or their ethnicity. This research found that black and minority ethnic graduates, and doctors who qualified overseas, were believed to face additional risks affecting their progression through training pathways.

In part two, Medical Royal Colleges and faculties and NHS Employers were asked to reflect on the risks identified in part one of the research, to consider the significance of each on the progression of doctors from different demographic backgrounds and also how amenable to change each risk might be.

What were the key findings?

  • The additional risks faced by UK graduate – Black and Minority Ethnic (BME UK) doctors and those graduating from a medical school outside the European Economic Area (International Medical Graduates or IMGs) identified in part 1 of the research were all regarded as significant by participants representing Medical Royal College and faculties and NHS Employers. Particularly significant was being ‘different’ from the dominant or majority group (eg lack of familiarity with UK cultural norms).
  • Participants were more pessimistic about the possibility of removing or mitigating the identified risks requiring large-scale political or cultural change than those risks they felt able to influence personally.
  • The risk regarded as most significant, that IMG are inexperienced with UK systems and cultural norms, was perceived as most amenable to change.
  • A range of initiatives which attempt to reduce risks to progression, particularly for IMGs, were identified by participants. Examples of these, from Royal Colleges and other institutions, are detailed in the report.
  • Barriers to change identified included the difficulty of discussing race with trainees and the potential unfairness of ‘positive action’.
  • Facilitators of change included research evidence, which could help persuade regarding the need for change, and improved knowledge about what interventions are effective.

To read Part two- Fair Training Pathways for all: understanding experiences of progression

Read more: Part one - Fair training pathways for all: understanding experiences of progression

Other research we have published about patterns of progression

Published Date Research Title Description
July 2016 Fair training pathways for all: understanding experiences of progression (pdf) - Part one In 2015 we asked researchers from University College London to develop the model proposed by HEFCE commissioned research (described below), in the context of postgraduate medical education and training to help us understand more about how differential attainment affects doctors in training.
July 2016 How doctors progress through key milestones in training (pdf) A summary of key messages arising from the publication of exam, ARCP and recruitment data for the 2014/2015 academic year
November 2015 Understanding differential attainment across medical training pathways: A rapid review of the literature. We commissioned an independent review of existing research and literature on differential attainment across medical education pathways. We want to understand potential causes of differential attainment; ways in which differential attainment has been researched; and potential interventions.
November 2015 GP selection data research This research investigates the correlation between selection scores and exam performance of GPs over a number of years.
Q4 2015 The state of medical education and practice in the UK Our fifth annual GMC report sets out what is happening in the education and practice of doctors, and considers some of the current challenges facing the profession and the systems in which it works.
November 2015 Building our understanding of professional support services offered to doctors in training (pdf)

To identify how doctors in training are supported, we worked with the Conference of Postgraduate Medical Deans (COPMED) to survey deaneries and local education and training boards across the UK.

Our survey of professional support units aimed to draw on the expertise and experience within these organisations to identify and share effective practice.

March 2015 Preliminary analysis of data on postgraduate exams and recruitment (pdf) A summary of key messages arising from the publication of exam and recruitment data for the 2013/2014 academic year
January 2015

GMC Corporate Conference Workshop

Read our overview of the workshop themes and discussions (pdf)

In January 2015, we held a workshop on differential attainment at our annual conference. We used the conference as a key moment to share emerging findings with a range of healthcare professionals, and to get their feedback about our approach to the research and what they think we should prioritise.

View slides from our differential attainment workshop

(ppx).

2013 Independent Review of the Membership of the Royal College of General Practitioners (MRCGP) examination

In 2013 we asked Professor Aneez Esmail to carry out an independent review of the Membership of the Royal College of General Practitioners (MRCGP), an integrated assessment system, success in which confirms that a doctor has satisfactorily completed specialty training for general practice.

The table attached shows the progress we, and other organisations, have made against the recommendations in the review’s final report.

How much do we already know about patterns of progression?

Our preliminary analysis of data on postgraduate exams and recruitment (pdf) found patterns that are broadly consistent with other research carried out in medical education, and in higher education more generally. It shows that age, gender, ethnicity and place of qualification all appear to be associated with the likelihood that doctors will progress.

In order to progress this work we need to explore these patterns and associations further, hence the GMC has commissioned research to support this.  In 2015 a review of research commissioned by the Higher Education Funding Council England and carried out by King’s College London, ARC Network and the University of Manchester identified four causal factors that are linked to differential attainment of higher education students. These categories focus on the differential experiences of learners in the learning environment, and help us to move beyond a model of attainment that is predicted solely on individual factors.

In 2015 we commissioned researchers from University College London to develop this model further in the context of postgraduate medical education and training to help us understand more about how differential attainment affects doctors in training. You can read the findings of this research here.

What are we doing to understand more?

We know that differential attainment starts at earlier stages of education, and we are currently developing analysis that will enable to us understand more about how these patterns develop as students and doctors progress through medical education systems.

We are also working with education and training organisations to develop systems for tracking and monitoring differential attainment at local level. By working in this way, we can better understand regional and programme level variation in performance. Over time, these data may enable education and training organisations to measure the impact of interventions that are being implemented and prioritise and target their action.

Research and analysis

Literature review 2015

We commissioned an independent review of existing research and literature on differential attainment across medical education pathways. We want to understand potential causes of differential attainment; ways in which differential attainment has been researched; and potential interventions. Please find more information and the final report below:

Understanding differential attainment across medical training pathways: A rapid review of the literature

GP selection data research 2015

This research investigates the correlation between selection scores and exam performance of GPs over a number of years. Please find the published GP selection data research here.

2015 State of medical education and practice in the UK report

Our fifth annual The state of medical education and practice in the UK report sets out what is happening in the education and practice of doctors, and considers some of the current challenges facing the profession and the systems in which it works.

Good practice

Case studies

As we continue our investigations, we're collecting examples of good practice in supporting doctors in training that have been identified locally and may be shared more widely. You can find each case study listed below:

Case study Stage Specialty 
Indicators that may be used for predicting doctors in difficulty Higher General practice
Additional support for doctors in training who are identified as at higher risk of failing exams Higher General practice
Support for doctors in training who have communication challenges due to language or cultural influences Foundation, Core, Higher  
A programme to raise educators awareness of clinical communication issues Higher General practice
A tool to codify underperformance issues Foundation, Core, Higher  
Support groups for students at higher risk of failing Foundation, Core, Higher  

Survey of professional support services 2015

To identify how doctors in training are supported, we worked with the Conference of Postgraduate Medical Deans to survey deaneries and local education and training boards across the UK.

Our survey of professional support units aimed to draw on the expertise and experience within these organisations to identify and share effective practice. Please find the final report below:

Building our understanding of professional support services offered to doctors in training.

GMC corporate conference workshop (March 2015)

Differential attainment: Understanding variations in performance in exams and training

In January 2015 we held a workshop on differential attainment at the GMC conference. We used the conference as a key moment to share emerging findings with a range of healthcare professionals: to get their feedback about our approach to the research and what they think we should prioritise going forwards. An overview of the workshop themes and discussions can be viewed here.

Taking action to ensure fairness

Equality and diversity guidance for medical royal colleges

We require the bodies we regulate to actively consider equality and diversity issues in all their work. We're committed to fair and non-discriminatory treatment of all patients, doctors in training, employers and educators affected by the education programmes we approve. When colleges and faculties seek our approval for changes to curricula, examinations and assessments, they should respond proportionately to equality and diversity issues raised by the changes. Our new guidance sets out the principles for providing evidence on equality and diversity when submitting changes for approval.