Monthly Archives: March 2022

Closing the Gap – Understanding Differential Attainment

Closing the Gap – Understanding Differential Attainment

Differential attainment

When it comes to differential attainment, that is the gap in achievement in assessments across different demographics, research shows that Black and Minority Ethnic (BME) doctors perform less well than their white peers.

The General Medical Council has found that UK-Qualified white candidates have an average 75% pass rate in postgraduate exams compared with 62.7% for UK-qualified BME candidates and 42.7% for non-European international medical graduates. The instinctive reaction is to think that this is a statistical error. After all, how could a gap in attainment exist using ethnicity as a determining factor? But perhaps the issue is that the instinct is to disbelieve the outcome rather than question how the outcome came about.

The list of assumptions about what causes the gap in attainment are endless, and often whittle down to language barriers, prior academic performance, socioeconomic status, or examiner bias. The challenge with assumptions is that they’re often not backed up by evidence, and the same can be said about assumptions about differential attainment. There is no evidence that any of these factors can explain the differences seen in undergraduate medical studies.

Why is there a gap?

Understanding what causes a gap is difficult because the factors that have an impact are broad. However, a 2015 review of differential attainment in undergraduate studies across the UK, identified four areas that could offer better insight into what causes the gap:

  • Students’ experience of the curriculum (this could be teaching and assessment practices)
  • Social and cultural capital
  • Relationships between staff and students and among students/ a sense of belonging and support
  • Psychosocial and identity factors (expectations that academic staff have of students and that students have of themselves).

How do we work to close the gap?

Sadly, there are no quick fixes to close the gap but there are things we can do to slowly change the outcome. Support and sponsorship by senior colleagues can mean the difference between progressing and not progressing in your career. Unconscious bias can influence who gets that support and sponsorship, and it is in larger part due to stereotypes and preconceptions senior colleagues might learn over time. Programmes that focus on discussing self-awareness, stereotypes, and power imbalances can help tackle closing the gap.

Creating a positive learning environment can also help close this gap, with teachers encouraging more questions and discussions among students. A study of social and cultural influences on higher education found that BME students were less likely than white students to seek help from or work collaboratively with their peers, giving their non-BME students an advantage.

Finally, inclusion is vital in creating a less competitive and more nurturing environment. Inclusion can mean capitalising on different approaches rather than just accepting they exist. Inclusion can help improve people’s sense of belonging as well as their own confidence, which leads to change in the difference in attainment.

These are just a few ways in which the difference in attainment can be tackled, but if you’d like to learn more about differential attainment or unconscious bias in medical education head to to browse through our library of webinars or continue reading to find out more with our Q&A session with Pauline Grant.

Pauline Grant Q & A

There is a common misconception that the differences in performance in medical education might relate to language, prior academic performance, socioeconomic status, or examiner bias.

However, therefore is no proof that any of these factors explain the differences seen in undergraduate medical studies.

We recently had the pleasure of speaking with Pauline Grant who runs the differential attainment for BME UK and international medical graduates training, and the unconscious bias training for clinical educational supervisors.

You can also watch a short clip from our talk with Pauline below:

Here are some of the highlights from our conversation…

Pauline, could you explain what differential attainment is?

“It’s something we see happening in schools, higher education, and across professions, where there is a gap in attainment between different groups of people. It’s usually based on people’s backgrounds, whether it’s black or ethnic minority trainees or students. It’s very much around the level that they attain in terms of exam pass rates in comparison to their white peers.”

Why does this gap exist?

“This is the question I think that people are grappling with and are trying to find the answers to. Sadly, there is no one or simple answer. I think there are a lot of myths about some of the reasons for differential attainment.

Some people will say it’s because ‘black and ethnic minority graduates or international medical graduates are not as bright or not as educated as the white medical graduates,’ or that it’s language barriers. If you’re an international medical graduate and English, isn’t your first language, is it that there’s a language barrier or is it exam bias?

There are lots of myths and different reasons that are posed, but there’s not a simple answer. There is an awful lot of research in the area and what it shows is that the issue relates predominantly to the learning environment.”

What is a misconception about unconscious bias training?

“What you see in the news with regards to unconscious bias training is that everybody would say it doesn’t work. I disagree. Does any kind of training work if you don’t actually apply it? There’s something about being in a learning space and consuming the knowledge that you’re being given. It’s about what you do with it, isn’t it? It’s about what you do when you take it away and how you practice.

I think whether it’s unconscious bias training, medicine, teaching or anything else that you’re doing, if you just do the learning and you tick the box and don’t do anything with it, it’s not going to work. For me, it’s about understanding what you can do on an individual level. So, you’re understanding what’s going on, you’re looking at the issue, and then you’re thinking about how do I take this away? How do I use what I’ve learned in my practice?”