Overall summary

Overview of group differences in Medical selection and education

• Within the academic literature and based on the outcomes of stakeholder consultation, it is evident that the patterns of group differences observed in GP selection (across a number of years) are common, consistent findings across selection practice, both in medicine and other contexts.
• Generally, White candidates perform better than other ethnic (non-white) groups on a variety of assessments (e.g. presentations, exams, interactive exercises) and on the whole are more successful in selection.
• The literature also confirms a pattern of overseas doctors (doctors who received their medical training and qualification outside of the UK) and international medical graduates performing less effectively than UK-trained candidates. In addition some ethnicity differences are less significant within UK-trained populations.
  • The patterns in the literature lend further weight to the findings of additional regression analysis conducted as part of the 2011 equalities impact report, which highlighted place of medical qualification as explaining the greatest amount of variance in GP Selection Centre total scores. Ethnicity and Gender only explained a minimal amount of additional variance suggesting the place of qualification was a more significant factor in explaining differential selection performance.
  • If competition increases within the UK for GP specialty training posts (as well as other medical specialities), the observation from 2011 in terms of a decrease in non-UK trained candidates successful during GP selection, could potentially continue. Stakeholders consulted during this process recognised greater competition for job roles within their fields and believed that group differences were likely to continue to emerge over the coming years.
• The literature and stakeholders in other environments also confirm that group differences exist for gender (female candidates perform better than male candidates), however these differences are not always significant and the pattern is not as profound as that for ethnicity. There is some evidence also to support age-related group differences with younger candidates performing more effectively.

Causes of group differences in Medical selection and education

• Both the literature and stakeholders within other contexts, suggest that cultural differences play a large role in explaining the differences in selection performance between different ethnic groups and more specifically UK versus non-UK trained candidates.
  • Models such as that of Hofstede (1984; 2001) and Schwartz (1992; 1994) highlight the cultural differences in values between countries and demonstrate the impact such differences can have on communication, interpretation and understanding.
  • Similarly differences in thinking styles, as influenced by a background in an Eastern or Western culture, could also impact on interpretation of written or verbal communication.
• Based on stakeholder consultation, socioeconomic background was considered to be a factor of growing importance in contributing to our understanding of the causes of group differences in selection.
• The research indicates that cultural differences in healthcare systems and roles within healthcare could result in different experiences for overseas doctors, impacting on their ability to adapt to the UK healthcare culture and model.
• Psychological explanations in terms of the impact of stereotypes and unconscious bias were also identified within the literature and by a number of stakeholders.

Guidance or interventions to support the reduction of group differences

• Comprehensive information to prepare candidates for the selection process should be maintained on the GP recruitment website e.g. descriptions of exercise format and information about what is expected in terms of the outcomes and measurement of exercises. Best practice within the literature and the experience of other stakeholders is that this is a useful source of information for candidates.
• The current information and guidance available to candidates (in GP and other specialities) focuses heavily on processes and structures. In addition guidance, information and advice about careers in GP, and the NHS more widely, are spread across a number of different resources. Whilst there are links on all websites to assist with accessing the various information sources, overseas doctors may find this hard to navigate.
• Current guidance may not necessarily provide adequate information about ethical/professional standards however by the nature of their design, the assessment materials present professional and ethical dilemmas to respond to. In addition the behavioural competencies assessed will address these standards therefore ensuring candidates receive some exposure to and gain an understanding of these principles prior to selection which should prepare them adequately.
• Best practice (i.e. GMC recommendations) and the outcomes of stakeholder consultation indicate that external review and inspection of processes ensures objectivity in selection e.g. use of external equality and diversity advisors or specialists.
• A number of possible areas for further research have been identified as there is still an absence of a conclusive explanation for group differences and a successful intervention to reduce their occurrence in selection. For future reference, Professor Patterson and colleagues have recently reviewed the issues relevant to GP in an editorial in the British Journal of General Practice (Dec, 2011) which provides recommendations on a future research agenda in this area (Patterson, Denney, Wakeford, Good, Making assessment fair and equal in postgraduate training; A future research agenda. BJGP, 2011, 61(593):712-713).