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Differential Attainment

 

The term “differential attainment” in medical education refers to systematic differences in educational and training outcomes between defined groups of doctors, medical students or resident doctors.  These differences in outcomes are seen in recruitments, Annual review of competence (for example by ethnicity, place of primary medical qualification (PMQ), disability, gender, socioeconomic background, mental health) and do not reflect individual variation in ability. 

The Yorkshire & Humber deanery is committed to tackling differential attainment within the Deanery.  This has led to the initiation of several projects across different career stages of the medical workforce including the reverse mentoring scheme. 

There are also several resources on differential attainment in academic literature, which you may wish to read further:

 

 

 

 

 

Reverse Mentoring

  • Involving trainees from ethnic minorities and trainers across all levels inlcuding TPDs, Deans, Heads of Schools, Clinical and Educational Supervisors. Find out more here.

Conscious Decision Making Training 

  • Available to all trainers and trainees to improve cultural competency and cultural awareness in a safe space. Check out the EDI courses page for dates.

Diversity in Medical Education (DiME) Project

  • The Diversity in Medical Education leadership programme was previously offered by NHS England as a positive action measure to promote leadership amongst their minority ethnic training program directors (TPDs).
  • The programme was a flagship initiative and aimed to broker the gap between a lack of ethnic minorities in leadership positions such as training programme directors.
  • Overall, DiME is an invaluable and important programme that needs developing further to ensure it has its potential impact. Without this programme, participants faced a range of barriers and are likely to be hindered in their career development. NHS England are currently working to determine whether this programme could be rolled out further.
     

Differential Attainment Resources for Resident Doctors and Trainers

  • We developed range of resources including case series, early support pathway, discussion prompts to complement existing EDI work by raising awareness and focusing on practical, system-aware actions that support resident doctors and their trainers in addressing differential attainment in real training environments.  

  

 

  

 

Why Does Differential Attainment Matter?

National evidence shows that resident doctors and medical students from ethnic minority backgrounds can experience poorer outcomes than their White peers across key training milestones (e.g., recruitment and ARCP).  

The National Training Survey (NTS) results show that daily experiences can affect training outcomes. The data highlights that differential attainment is important because resident doctors do not experience the workplace in the same way. These differences can lead to unequal learning and career progress.  

 

Daily Experience of Microagressions in Yorkshire& Humber Resident Doctors by Ethnicity (%) 

(National Training Survey (NTS) 2025 Data)

 

 

 

Reported Confidence in Accessing Support Contacts in Yorkshire& Humber Resident Doctors by Ethnicity (%) 

(National Training Survey (NTS) 2025 Data)

 

 

In Yorkshire and Humber region, 53% of White resident doctors say they know how to report discrimination, compared to 46% of Asian resident doctors (UK benchmark is 40%). But fewer resident doctors feel confident in reporting discrimination. Evidence suggests variation between groups, with confidence lower among some ethnicities: 43% of White resident doctors report confidence compared with 34.4% of Asian resident doctors, 37% of those of mixed ethnicity (UK benchmark: 40%). 
NTS 2025 results show that certain groups are more at risk of unacceptable behaviours than others. 39% of gay and 45% of bisexual trainees reported hearing discriminatory comments, compared to 24% of heterosexual trainees across the UK. In Y&H region only 36% of bisexual resident doctors feel confident in reporting discrimination and only 31% of bisexual resident doctors think staff are treated fairly, compared to the UK benchmark of 39%.   . 
This means that the issue is not just knowing the policies, but whether resident doctors feel safe and supported to raise concerns early.   

Some resident doctor groups report microaggressions more often than others. Microaggressions are experienced weekly by 7.9% of mixed-ethnicity, 6% of Asian, 5.1% of resident doctors in the 'Other' ethnic group. All of these are higher than the UK benchmark of 4.7%. Reports of daily microaggressions were also higher among internationally qualified resident doctors (2.20%) compared with UK graduates (1.76%). Additionally, 7.9% of resident doctors with a recorded disability reported experiencing microaggressions, compared with 1.67% among those without a disability (UK benchmark: 1.72). 

Among resident doctors holding a European primary medical qualification, 10% report experiencing unequal training opportunities daily, compared with 3.3% across the UK. These numbers indicate that some resident doctors face more frequent undermining behaviour and less consistent access to opportunities. 

These experiences are important because they can lead to differential attainment in clear ways. When resident doctors feel less included, face more microaggressions or incivility, get less consistent feedback and support, or feel unable to speak up, they are more likely to delay asking for help, miss opportunities to develop, lose confidence and belonging, and feel more stressed. These factors can lead to worse progress and recruitment results. Differential attainment is an equity and Equality, Diversity and Inclusion issue, so action is needed at every level: individual, team, organisation, and system. For Y&H, this means building psychological safety, creating trusted ways to raise concerns, improving daily inclusivity (including addressing microaggressions and incivility), making opportunities more transparent and fairer, and giving consistent, high-quality feedback and proactive support to groups with poorer experiences. 

References: General Medical Council National Training Survey Data Tool and 2025 results report.

 

 

 

Differential Attainment Case Series

The following cases are examples drawn from lived experience of Yorkshire and the Humber (Y&H) resident doctors and informed by published UK research on differential attainment. 

Identifying details have been removed and scenarios synthesized to preserve confidentiality while maintaining the integrity of the learning points. 

These cases illustrate how structural factors including access to informal networks, familiarity with training systems, neurodiversity, disability, workplace design, and exam preparation environments may interact with progression outcomes. 

Each case highlights practical supervisory actions and system-level adjustments that can reduce differential impact and support equitable progression within standard training pathways across Y&H. 

 

Click to download the case you want to read.

Case 1: Early Structured Support for a Non-UK Graduate in Core Training 

Case 2: Exam Performance and Access to Informal Learning Opportunities 

Case 3: Workplace Adjustment for a Resident doctor with a Physical Disability 

Case 4: Recognising Neurodiversity in a Resident doctor with Time Management Difficulties 

Case 5: Resident doctor with Health Condition-Early Discussion and Workplace Adjustment 

Case 6: Multiple Exam Failures caused by Lacking Peer Support 

 

What Can Resident Doctors Do?

Differential Attainment is not caused by a lack of ability, capability, motivation, or professionalism in resident doctors. Differences in progression and outcomes arise from systemic, cultural, and structural factors within training environments.   

From a resident doctor perspective, DA may be experienced as feeling less confident in unfamiliar systems, having expectations that are unclear, receiving inconsistent feedback, or being unsure when and how to ask for help. These experiences are common and valid, yet they often remain unspoken until difficulties escalate. The resources in this section are designed to support early recognition of challenges, encourage reflective practice, and empower resident doctors to engage proactively with their training.  

Taking small, proactive steps early can make a difference to your training experience. The resources below are created to help you recognise challenges early, access support confidently, and engage more effectively with supervision and training opportunities.  

These resources are resident doctor-owned and flexible. You may choose to use them independently, share them with supervisors, or adapt them to suit your individual circumstances. The actions and resources in this section are not intended to place responsibility on individuals, but to support resident doctors in navigating training systems, accessing support early, and protecting their wellbeing while organisational and structural work continues to address the root causes of differential attainment. 

 

 

Practical steps resident doctors can take include: 

  • Understanding who is there to support you and how to contact them (Educational Supervisor, Clinical Supervisor, Training Programme Director, Professional Support Unit, Freedom to Speak Up Guardian, Guardian of safe working, International Medical Graduate Representative, Local Resident Doctor Groups, Disability Champion, Line Manager) 

  • Joining peer networks, or creating your own network locally (IMG groups,  disability networks, or LGBTQ+ networks.)  Click to download List of Peer Networks.

  • Using your network to exchange information such tips on exams preparation, courses and other opportunities 

  • Protecting your health and wellbeing by using available resources such as coaching, social prescribing, reasonable adjustments, and maintaining time for rest, connections, and hobbies.  

  • Maximize use of opportunities available to you such as coaching, enhanced induction, LSFD courses, language courses and other local and national opportunities 

  • Reflecting early, planning goals ahead, and monitoring your own learning and support needs using structured tools. Learning & Development Planning Discussion Prompts are produced and available  to be used during supervisory meeting (available to download) 

  • Preparing for supervisor meetings with clear examples, priorities, and specific support requests. 

  • If something feels unfair or you experience microaggressions or challenges related to cultural awareness, you are not expected to manage this alone and may seek early support in a way that feels safe for you. 

  • Asking for support or raising concerns earlier rather than later, to prevent escalation. 

 

Courses/ Support Links: 

  • Enhancing Colleague Relationships Through Culturally Sensitive Communication- available via maxcourse 

  • Resident doctor passport is being piloted. Can be downloaded from the deanery website. Contact TEF for further information. 

  • SuppoRTT- Supported Return to Training is also available for resident doctors returning to training after long term absence.

 

What Can Trainers Do?

Advancing equity in training is a core component of high-quality postgraduate education.  Addressing DA is a significant part of good EDI practice, and we must
actively work to reduce the awarding gap in line with expectations set out by the General Medical Council.  Addressing Differential Attainment supports fair access to opportunities, psychologically safe learning environments, and consistent progression for resident doctors. Educational and Clinical Supervisors play a key role in advancing equity by recognising barriers early, providing inclusive supervision, and providing timely support.      

Trainers play a pivotal role in advancing equity through everyday supervisory practice. From an EDI perspective, Differential Attainment may be reflected in  resident doctors having unequal access to informal guidance, experiencing microaggressions or cultural misunderstanding, receiving feedback that is interpreted differently, or feeling less psychologically safe to ask for help. These should be understood as signals of inequity that prompt support within training environments,  rather than as individual deficits.  

Advancing equity in training requires both EDI awareness and practical action. Meaningful change happens when equity principles are translated into everyday supervisory  practice.  

 

Key actions trainers can take to advance equity include: 

  • Creating psychologically safe learning environments where difference is recognised, respected, and openly discussed, and where help-seeking is normalised. 

  • Making expectations, assessment requirements, and unwritten rules explicit, particularly for resident doctors new to UK systems or unfamiliar training cultures. 

  • Using structured supervisory tools to reduce subjectivity, increase transparency, and support fair, consistent decision-making (e.g. reflection templates, activity trackers, meeting logs). 

  • Providing clear, specific, and actionable feedback, and actively checking understanding to reduce differential interpretation. 

  • Responding early and proportionately to emerging concerns, agreeing supportive actions collaboratively and reviewing them regularly. 

  • Recognising and responding to experiences related to microaggressions, cultural awareness, or unequal access to opportunities, and seeking advice where appropriate rather than managing these issues in isolation. 

  • Engaging with cultural awareness and inclusive supervision learning, such as LSFD courses and NHS Learning Hub resources, to strengthen understanding of diverse resident doctor experiences.  

  • Using reverse mentoring approaches to learn directly from resident doctors’ perspectives and to challenge assumptions embedded within training systems. 

  • Recognising that resident doctors are a diverse group and that effective support must be bespoke and individualised, rather than relying on a one-size-fits-all model. 

     

    Tackling Differential Attainment: An Early Support Pathway 

    Description: Downloadable Flowchart
    This flowchart provides a practical framework for trainers to identify and respond early to key factors contributing to differential attainment. It emphasises inclusive supervision, early supportive action, and equitable access to opportunities, while recognising that differential attainment arises from systemic and structural factors within training environments. 

    Click HERE to download the pathway.

    Resources for Trainers:
     

  • LSFD Maxcourse Educator and Trainer  Development Courses – https://www.yorksandhumberdeanery.nhs.uk/faculty 
     

  • GP DA Trainer Curriculum https://www.yorksandhumberdeanery.nhs.uk/general_practice/da-trainer-curriculum 
     

  • NHS Humber Health Partnership offers GMC workshops (eg. Supervising International Medical Graduates; Creating respectful, fair and compassionate workplaces) for their staff. Details can be found out by emailing hyp-tr.hhpmd.revalidationteam@nhs.net 
     

  • An open-access Differential Attainment Toolkit supporting educators to understand differential attainment, facilitate challenging conversations, promote cultural safety and humility, support exam preparation, careers coaching, and supervision of resident doctors from diverse cultural and linguistic backgrounds. Designed for flexible, local use with modular content.  Authored by Dr David Mendel and Jacqueline MacDonald-Davis, contributed by Workforce and Education Research NHS. 
     

  • IMG support resources for educators https://www.yorksandhumberdeanery.nhs.uk/learner_support/support-international-medical-graduates/img-resources-educators-and-trusts 
     

  • Academy of Royal Colleges Facilitating Reflection- A guice for Supervisors https://www.aomrc.org.uk/wp-content/uploads/2019/06/Facilitating_reflection_0619.pdf 
     

  • The WelcomInG Form and CARAT forms are structured forms created to be used by the IMG and their Clinical or Educational Supervisor during their supervisory meeting. 
     

  • Learning & Development Planning Discussion Prompts are produced and available to be used during supervisory meeting (available to download) 
     

  • Trainee resources above can be used to signpost your trainees.

 

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