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Race and deprivation set back medical trainees, GMC analysis finds

Published on: 2 Mar 2023

New research shared with HSJ  has ‘laid bare’ the inequalities experienced by medical trainees, with black doctors more likely to perform worse in exams than any other ethnic group.

The report published by the General Medical Council today highlights that UK medical graduates of black or black British heritage have the lowest specialty exam pass rate of all ethnic groups at 62 per cent, which is almost 20 percentage points lower than that of white doctors (79 per cent). It is the first time the medical regulator has split this data by ethnicity, it said. 

The GMC said poorer outcomes may be compounded by socio-economic status, with black/black British trainees from areas with higher deprivation having an even lower exam pass rate.

The research found a 10 percentage point gap in pass rates between the lowest and highest social economic backgrounds on average.

Efforts to attract more poorer graduates appear to be failing: In 2021, only 7 per cent of trainees sitting specialty exams came from the most deprived areas, compared to 39 per cent from the most affluent – proportions “broadly unchanged since 2014”. 

The analysis found a larger proportion of black/black British trainees had to extend the length of their training programme than white trainees, and were more likely to receive an “unsatisfactory” review from their ARCP (the annual review of competencies for post-graduate doctors).

The report found no evidence so far the attainment gap between different ethnicities is significantly narrowing.

It concludes that “training organisations need to tailor their approaches and interventions to address differential attainment” and “challenge disadvantage and discrimination in medicine”. 

The report does not, however, analyse or draw any conclusions about the reasons for the variation. 

According to latest GMC data, 46 per cent of all medical trainees in the UK have a minority ethnic background, and 19 per cent of the total are international trainees.

The GMC has pledged to “eliminate discrimination, disadvantage and unfairness” in undergraduate and postgraduate medical education by 2031 and the disproportionate number of fitness to practise complaints received about ethnic minority doctors and doctors who gained their medical qualification outside of the UK by 2026.

The research reiterated previous findings that doctors who qualified overseas have worse outcomes in specialty exams than those who trained in the UK – the difference in average pass rate between the two groups was 26 percentage points.

Again, the gap was found to be wider for certain ethnic groups, with black trainees from within the European Economic Area hitting just above 40 per cent on average in specialty exams, compared to just under 60 per cent achieved by white and doctors of mixed ethnicity.

GMC chief executive Charlie Massey said the new data “lay inequalities bare” and “gives shape to the detriment long experienced by ethnic minority doctors”. 

In a comment piece for HSJ today, he adds: “For too long, a significant and growing proportion of the workforce has seen their development and progression undermined, damaging not only their prospects but the quality of care they’re able to provide.”

Although the GMC makes no specific recommendations, Mr Massey said it had commissioned researchers to “evaluate a workshop for [medical] trainers”, as trainers have a “key role to play”.

NHS England last month published an action plan on medical race and ethnic discrimination, including objectives to tackle disproportionate disciplinaries and GMC referrals for ethnic minority and international medical graduates; and put in place better support for international graduates.


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