Differential Attainment

Addressing Differential Attainment in Primary Care

What we did

Over the past 6 months, we have developed a strategy in collaboration with HEE local offices to provide additional support to GP trainees, with the aim of reducing and eventually eliminating differential attainment (DA). The support focuses on GP trainees with non-UK qualifications as they acutely experience differential attainment but will also help UK graduate GP trainees from ethnic backgrounds as well as trainees with other protected characteristics.

The principles of the strategy are to provide equitable access to the curriculum for all trainees, to enhance their training experience, and to improve their outcomes. There have been 3,690 acceptances to HEE GP Specialty Training programmes for the August 2021 intake and over half (around 53%) of these trainees are International Medical Graduates who will directly benefit from this targeted support, along with IMG GP trainees who are already in training. 

£4.5m of additional funding has been identified for this programme in 2021/22 through the Spending Review funding allocation process. This funding has been distributed to HEE local offices so they can deliver the support and tailor their offer to the needs of their local GP trainees. HEE local offices are using this funding to recruit extra educators and administrators to implement the additional support.

DA leads have been identified across all HEE local offices and a community of practice has been established to assess current processes and formulate best practice. Current best practice includes the early identification of additional support requirements, enhanced induction, personalised learning plans, support with e-portfolio and ARCP preparation, as well as additional exam and communication skills support.

Concurrently, a toolkit of resources has been produced and shared to support faculty development in HEE local offices. The toolkit is intentionally adaptable and versatile to provide a good level of materials for educators to use with all learners. This resource includes training on unconscious bias, bystander training, culturally sensitive conversations, diversity, inclusion and belonging, equity and fairness in training, feedback and difficult conversations, as well as raising awareness of racism and racial justice.

What we will do

This programme will be evaluated through a combination of quantitative and qualitative metrics. These include reporting on exam and ARCP outcomes, a breakdown of how the additional funds have been allocated, and a ‘heat map’ on how local offices have implemented the areas of best practice along with narrative statements. Success of the programme will be defined by these outcomes and hopefully reflected in national trainee satisfaction surveys. The one-year financial settlement for 2021/22 coupled with evidence from the evaluation will help support future Spending Review bids ensuring that funding to support GP trainees is available in future years and becomes incorporated into baseline budgets.

Addressing Differential Attainment in Secondary Care

What we did

Nationally HEE is seeking to explore how we can better support trainees who did not complete their Foundation Training Programme in the UK. The numbers of trainees entering UK training programmes using the CREST (Certificate of Readiness to Enter Specialist Training) has steadily increased over the last 5 years with significant variation by region. The percentage of trainees appointed into Internal Medicine Training Stage 1 (IMTS1) using the CREST route has gone up from 12% to 28% from 2016-2020 with over 40% in some regions.

These trainees are more likely to be from non-UK backgrounds as defined by their country of primary medical qualification (PMQ). CREST trainees are potentially at risk of differential attainment (DA) as they may struggle to engage with the programme. These trainees will need early targeted support based on their individual training needs.

Over the last 12 months, in IMT, there has been a programme of work to better integrate and support trainees entering through the CREST route. 

A survey was conducted of IMTS1 trainees appointed through CREST towards the end of their first year in July 2020. The majority, 98.7% had not undertaken any postgraduate medical training post in the UK prior to taking up this post. 

What we will do

Based on this and the wider programme of work, we have proposed a strategic framework to support CREST trainees. This framework is potentially transferable to all specialties and programmes and some aspects can be tailored as required.  It is acknowledged that no single intervention can eliminate this risk and therefore a strategic multi-level approach is proposed:

Recruitment/ selection/ placement

• Earlier identification of trainees and targeted support
• Allocation of placements and supervisors based on educational needs

Enhanced programme of induction

• SuppoRTT programme with targeted interventions as required (enhanced supervision, mentoring, coaching, referesher course/ simulation training)
• Offer additional support to trainees new to the UK - welcome to UK practice, BMA tools
• eportfolio training

Educator support

• Cultural competence
• Unconscious bias training
• Cultural safety
• Personalised learning plans

Multiple targeted interventions based on educational needs

• Enhanced supervision
• Peer mentoring
• Exam support
• Support for ARCP preparation

The specific recommendations made are from work within the IMT programme, but the recommendations and proposed framework for interventions are applicable to all specialties and training programmes.