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Understanding experiences of progression

What were the key findings?

  • Postgraduate medical training presents risk for all doctors in training. But international medical graduates and UK graduates from black and minority ethnic (BME) communities face additional risks to progression when compared to their peers.

  • Good relationships with senior colleagues are crucial in providing learning opportunities for doctors in training. UK graduates from BME communities and international medical graduates were more likely than their peers to report difficulties in establishing and maintaining such relationships.

  • Reported instances of explicit prejudice were relatively rare. However, respondents perceived unconscious bias, including negative assumptions, to be an important factor that affects outcomes. They thought that increasing the diversity of decision makers was one way to mitigate or safeguard against the worst effects of this.

  • In medicine, failure is often believed to result from a lack of motivation or ability. Doctors in training felt they were not always given the support they needed to learn, or were blamed for problems they felt weren’t their fault.

  • International medical graduates could face particular challenges due to unfamiliarity with UK assessments, cultural norms and NHS or work systems.

  • Enablers of progression identified through the research were generally at a micro level, but could be affected by macro- and miso-level changes.

  • Trainers having protected time to get to know doctors in training, to exhibit belief in their abilities and to support them through challenges, can increase confidence and improve performance.

  • Opportunities to develop networks with peers, both from similar and different backgrounds, could help provide knowledge and support.

  • Having a good work life balance is important to make sure doctors in training don’t burn out.

Why did we commission this research?

We run a broad programme of work to better understand the nature of differential attainment and the actions we can take to help mitigate this. As part of this work, we wanted to understand what doctors in training and trainers perceived to be barriers to and enablers of progression.

What did the research involve?

96 doctors in training and 41 trainers took part in 16 focus groups and 49 interviews in November and December 2015. The researchers purposively sampled from:

  • four locations in England and Wales with different proportions of UK graduates and international medical graduates and differing average postgraduate examination performance

  • white and BME groups

  • UK graduate and international medical graduate groups

  • all stages of training

  • six specialties with differing competition ratios and proportions of international medical graduates, plus foundation training.

  • Trainers were interviewed to triangulate the doctors in training findings.

Read the full report

Fair training pathways for all: understanding experiences of progression