Intended for healthcare professionals


Differential attainment in medical education and training

BMJ 2020; 368 doi: (Published 11 February 2020) Cite this as: BMJ 2020;368:m339

Read all of the articles in our special issue on Racism in Medicine

Linked Feature

Taking the difference out of attainment

  1. Katherine Woolf, associate professor in medical education
  1. Research Department of Medical Education, UCL Medical School, Royal Free Hospital London, UK
  1. k.woolf{at}

A systemic problem requiring openness and strong leadership

Doctors from ethnic minority backgrounds face disadvantage throughout their careers, as highlighted by this collection of articles in The BMJ ( It is therefore unsurprising that despite being selected for high academic achievement, medical students from ethnic minority groups end up performing worse on average than their white counterparts during education and training. This phenomenon is called “differential attainment.”

Differential attainment appears at medical school and persists after qualification. As a result, ethnic minority graduates of UK medical schools have worse outcomes during recruitment for foundation, specialty training, and consultant posts; are more likely to fail examinations; and progress more slowly through training even when exam failure has been accounted for.1

Differential attainment is a difference in average group performance, not individual performance. Many ethnic minority students and doctors excel, and many white doctors perform poorly. The finding, however, that ethnic minority medical graduates in the UK have 2.5 times higher odds of failing exams compared with their white peers 2 is hugely important …

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