Annual Review of Competency Progression and Fairer Training Cultures (Differential Attainment)

With further development of the tool, offices will be able to consider programme results and this will help inform local action plans already in place. The tool will improve live access and reporting abilities and help consider particular differences in data by programme.

Improved data presentation and access will become routine business. A national comparison already shows the gap in attainment and work is well underway to support and invest in initiatives to support trainees, some of which are described in the good practice section.

A Combined Committee of Postgraduate Medical Educators (CoPMed) and Academy of Medical Royal Colleges forum are working together and meeting in June 2023 to consider next steps. This is an example of the system working together to coordinate and support initiatives to ensure fair training cultures and strive to reduce attainment gaps.

ARCPs are a key assessment to enable career and pay progression. Not only will Postgraduate deans analyse data by protected characteristics, education providers will also be encouraged to do so, as only just over 50% currently report this occurs.

Differential Attainment in Primary Care

The Primary and Integrated Care team are in the second-year delivery of the Differential Attainment (DA) programme. This programme seeks to reduce the DA that currently exists, working with regions to adopt interventions that specifically support International Medical Graduates (IMG) during their training programme. A programme of best practice has been developed and is being delivered across every local GP training location via regions with dedicated DA leads who are part of a community of practice. The interventions in place include:

• Enhanced induction programme, gaining exposure to the NHS healthcare system
• Early identification of learning support needs through assessment of IMG applications and proactive screening
• Navigating additional support for doctors and dentists in training and their families to settle into new communities using resources such as social prescriber link workers
• 1:1 support meetings creating personalised learning plans
• Focussed sessions on exam preparation and support
• Support with communication and consultation skills
• Faculty development, delivering workshops to educators to understand and use best practice to support this workforce

The ongoing monitoring of this work is through a set of Key Performance Indicators (KPIs) which relate to ARCP outcomes and exam success. In addition to the KPIs, an evaluation has been commissioned to conduct an economic analysis of the programme. The aim is to define the added value of this work and the impact of the interventions in place.

The overall benefits of this programme may take many years to be realised therefore there is a plan to commission a longitudinal evaluation of the programme In addition, the long-term impact it has had on addressing DA and supporting our IMG workforce will be reviewed.

Differential Attainment in Secondary Care

In secondary care, we have been doing a programme of collaborative (HEE, General Medical Council, Royal Colleges) cross specialty research to address differential attainment. We have focused on core training programmes (medicine, psychiatry, surgery). Following focus group feedback, the aim is to provide earlier identification and targeted trainee and trainer interventions to develop and improve personalised support for doctors and dentists in training to improve outcomes and trainee experience.

Formal evaluation of interventions has been done to measure impact and a strategic stepwise approach to support these doctors and dentists in training has been recommended and applied in different training programmes. The trainer interventions including educator masterclasses have shown change in practice of supervisors to support their doctors and dentists in training and provide more tailored support.

Doctors and dentists in training interventions including trainee masterclasses for specific exam support have showed significant improvement in the national examination outcomes in psychiatry. Work is currently underway in developing a specific learning needs analysis tool. This will aid structure of the initial evaluation of doctors and dentists in training and help towards planning the programme of bespoke support and then tracking progress.

We have done a lot of work on supporting the doctors and dentists in training entering through the Certificate of Readiness for Specialty Training (CREST) route with many large programmes (Medicine, GP, Psychiatry) having up to 40% of doctors and dentists in training from this route.

Enhanced induction, early access to portfolios, support for ARCPs, examinaion preparation and peer mentoring programmes have been shown to be of benefit to these doctors and dentists in training. These recommendations are being implemented through the regional offices and head of schools.

Further work needs to be done to reduce the variability of access of support across regions and improve the resources and support allocated for these doctors and dentists in training.

Levelling the Field

The Levelling the Field conference addresses the theme of ‘Championing Ethnic Diversity in the NHS’ and has run in 2020, 2021 and 2022 attracting over 4000 delegates from all corners of healthcare and around the globe.

We have addressed a wide range of issues in the past, including International Medical Graduate Induction, Bullying & Harassment, and the Disproportionate Impact of Covid in Ethnic Minorities.

Following feedback and requests, in 2022 we covered Empowering the International NHS workforce, and Differential Attainment. The programme discussed inclusive and compassionate leadership, workforce trends, sharing practice, personal stories, supervision, HEE Deans’ EDI Committee Annual Report 2022/23, supporting colleagues, the importance of language, regulation, and the role of the quality framework.

You can access the recording of the conference via The Medics Academy.

Twitter: @LTFinNHS

A Line Website: https://www.a-line.org.uk/ events/levelling-the-field-2023-584/

The conference is hosted by A-liNE, based in the North East and providing anaesthetic training and a hub of excellence.

Supported by Dr Jae Huh (Consultant Anaesthetist, Royal Victoria Infirmary) and Dr Kathryn Bell (Consultant Anaesthetist, Royal Victoria Infirmary), Dr Sameer Ahmed (Consultant Anaesthetist, Royal Victoria Infirmary) continues to organise the conference programme and lead real world change in the NHS.