Ascanio Tridente

The current issue of the journal includes an article providing unique insight into the experiences of international medical graduates (IMGs) new to the NHS, offering a unique perspective on their views, feelings and struggles. An important, connected and often underestimated matter is the thorny issue of differential attainment, and how it affects and blights IMGs’ careers. Differential attainment in UK medical training refers to systematic differences in performance, progression and access to training opportunities. Differential attainment is defined as variation in group, as opposed to individual, attainment based on the protected characteristics of age, gender, disability, marriage or civil partnership, pregnancy, race, religion or belief and sexual orientation, as defined in the Equality Act 2010. Differences have been reported among doctors in examination performance, clinical and academic career progression as well as the prevalence of interventions and sanctions by professional regulatory bodies. Some of these differences have been associated with individual characteristics, such as gender, ethnic background and country of qualification.1–5 Several potential reasons have been advanced, such as unconscious bias, discrimination, differences in development and training opportunities, and differences in medical training systems between countries. Differential attainment in medical training may be evident at early stages, such as medical school entry and progress. But it can also be seen in medical school examination success, postgraduate and interview outcomes, specialty access options and appointment to specialty training. It is also seen at more senior ends of the career spectrum such as consultant appointments and higher national opportunities and appointments as well as research and other opportunities. The General Medical Council has recently designated tackling the inequalities that exist in medicine as an urgent priority. Their recent findings are presented in a comprehensive report from 2023, highlighting inequalities in medical education, among ethnic minority doctors and international medical graduates.6 The report has described how factors such as religion, sexual orientation, socio-economic status and disability may influence attainment across groups, indicating the need for training organisations to tailor their approaches to address such differences. It is fundamental that the UK fosters a culture of fairness in training, and that opportunities for development, such as access to specialist training, management and leadership, are open to all. Recent legislative changes were implemented with the newly enacted Medical Training (Prioritisation) Act 2026, which received Royal Assent and passed into law on Thursday 5 March 2026.7, 8 The change in the law was implemented in response to growing concerns that UK trained doctors are facing increasing competition for training positions from overseas graduates. Under this new legislative framework, graduates from UK medical schools will be prioritized for access to foundation and specialty training roles, with the declared intention to ensure a sustainable domestic workforce. The new law has been welcomed and endorsed by the British Medical Association, which has also urged the Government to take further steps towards addressing the current UK medical job crisis.9 It remains unclear how the implementation of the Act will impact differential attainment. References Full Text File size: 132 KB Downloads: 104