Last updated:

Differential attainment - why it matters

Back of doctor in hospital, BMA News cover photograph, BME

What is differential attainment?

Differential attainment refers to ‘systematic differences in outcomes when grouping cohorts by protected characteristics and socio-economic background’, according to the GMC.

The biggest gaps in attainment during medical training are linked to race – with both UK BME and international medical graduates affected. This is seen across all specialties.

In 2017, GMC data shows the pass rate in postgraduate exams was 75% among white students and 63% among UK BME students. Among IMGs, the pass rate was 46% for white students and 42% for BME students.

A 2017 Pulse analysis of pass rates for the CSA exam found 94% of white and 80% of BME trainee GPs educated in the UK passed the exam at the first attempt last year. This gap is the widest since the RCGP started collecting figures in 2008.


What causes differential attainment?

Research by Dr Katherine Woolf, the leading academic on differential attainment, debunks many of the myths around this issue - including that it is linked to the academic ability of students themselves.

Her research shows that the issues relate predominantly to the learning environment.

Learning is a social activity, so it is unsurprising that in medicine, strong peer support and networks significantly affect performance.

Download the report


  • What makes a difference - tips for providers and trainers

    Recognising diversity

    Avoiding treating all students and trainees as a homogenous group, or putting all BME students in the same ‘box’.


    Improving cultural competence

    This is the ability to interact with people from different cultures and respond to their needs.


    Monitoring data

    Colleges and deaneries need to collect data on ethnicity and analyse it against performance throughout the student journey so that where there are problems, these can be quickly identified and addressed.


    Early intervention and support

    National student survey data shows that all medical schools could make improvements in the way they do assessments and give feedback.


    Mentoring and role models

    Seeing people ‘who look like you’ in the training environment can provide encouragement.

    Role models also contribute to challenging stereotypes.


    Taking a holistic approach to trainee performance

    Understanding the whole range of factors that affect a trainee’s performance.

    This could include mental health and well-being, practical issues around finances, housing, visas and immigration. 


  • See what doctors have to say about differential attainment

    We held a conference on 2 November 2017 to discuss the ongoing gap in attainment between BME and white medical students and trainees.

    Doctors and medical students spoke frankly about their experiences of differential attainment.


  • What makes a difference - tips for students and trainees

    Seek out other students and learn together

    A study group can create an effective and safe space to share problems, ask questions and check understanding of language and learning.


    Ask for help

    This can feel difficult and uncomfortable, but it can facilitate extra resources or support which can make a major difference to performance.


    Find a mentor or a sponsor

    Mentors can be an important source of support and guidance, particularly in a self-regulated learning environment. It is important to distinguish between mentors and sponsors. A sponsor can use their influence to help you progress and help to open doors.


    Give feedback

    Trainers, educators and others may use language or behave in a way that you feel is inappropriate and shows bias, but this may be because no-one has discussed this with them before.


  • Initiatives to tackle differential attainment

    General Medical Council

    The GMC has developed new standards for medical education and training and postgraduate medical curricula that reinforce fairness as a guiding principle and highlight equality and diversity considerations.

    It is working with three pilots (London, Scotland and East of England) to develop action plans, focussing specifically on ethnicity and Primary Medical Qualifications.


    HEE (Health Education England)

    HEE is proposing to introduce a targeted GP training support programme.

    This will enable doctors who did not successfully complete their GP training within the required time frame to re-enter the programme and support doctors from other specialties to enter GP training.


    HEE East of England

    The GP deanery in HEE East of England has adopted a three-pronged approach based on:

    • training - dedicated, individualised learning plans and career advice, with early warning systems for trainees who are likely to face difficulties in training
    • assessment - evaluation of assessment methodologies to eliminate bias; selecting and training examiners appropriately; and providing detailed, constructive feedback for unsuccessful applicants
    • monitoring - systematically monitoring, analysing and disseminating equality data.


    HEE North West

    In 2016 HEE North West formed an Equality, Diversity and Inclusion group, which has successfully engaged with trainees to identify factors that lead to difficulties with progression, and then worked to address them.


    The Royal College of Psychiatrists 

    The Royal College of Psychiatrists commissioned an independent review of its MRCPsych exams and encouraged local education and training boards and deaneries to set up a dashboard.

    This monitors key areas of progress such as individualised learning plans for trainees, offering mentoring, and giving remedial feedback after poor performance in exams. The College has held several conferences on differential attainment and support for IMG doctors.


  • Further resources