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Response to: Lagunes-Cordoba et al ‘International medical graduates: how can UK psychiatry do better?’

Published online by Cambridge University Press:  29 March 2022

Paul Tiffin
Affiliation:
Professor of Health Services and Workforce Research, University of York, UK. Email: [email protected]
Lewis Paton
Affiliation:
Lecturer in Data Science, University of York, UK
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Abstract

Type
Correspondence
Creative Commons
Creative Common License - CCCreative Common License - BY
This is an Open Access article, distributed under the terms of the Creative Commons Attribution licence (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted re-use, distribution, and reproduction in any medium, provided the original work is properly cited.
Copyright
Copyright © The Author(s), 2022. Published by Cambridge University Press on behalf of the Royal College of Psychiatrists

The paper by Lagunes-Cordoba et alReference Lagunes-Cordoba, Maitra, Dave, Matheiken, Oyebode and O'Hara1 makes important points in relation to differential attainment in psychiatry. However, we note the statement: ‘we note that technically the term “IMG” applies to a White British citizen who studies abroad and returns to work in the UK, yet such an individual is less likely to face attainment gaps’. This may not be entirely true, depending on what one means by ‘attainment’ in this context. We previously published a study using data drawn from the UK Medical Education Database (UKMED), which investigated educational performance and success at recruitment into specialty training for UK International Medical Graduates (IMGs). These are doctors who are UK citizens but have obtained their primary medical qualification outside the UK. We showed that, on average, ratings at the Annual Review of Competence Progression were poorer for UK IMGs than non-UK IMGs. Nevertheless, UK IMGs were more likely to be successful, compared with IMGs, when applying for a specialty training post.Reference Tiffin, Orr, Paton, Smith and Norcini2 This finding obviously raises issues of fairness, and effectiveness, in postgraduate medical selection. We would also wish to draw attention to our own recently published study of differential attainment in the MRCPsych examination, which was not cited in the paper, though highly relevant.Reference Tiffin and Paton3 This demonstrated that differential pass rates at the Clinical Assessment of Skills and Competencies existed for candidates (both UK graduates and IMGs) who identified as being from minority ethnic groups, even after controlling for the influence of performance on knowledge-based components of the examination. Similar findings were previously reported by Esmail, for the Clinical Skills Assessment component of the MRCGP.Reference Esmail and Roberts4 At the time we suggested that these differential pass rates were likely to have complex underlying causes but urgently required investigating and addressing. Understanding and addressing differential attainment is clearly a matter of social justice but is also essential to the well-being of the National Health Service, its patients and the overseas-qualified staff it has traditionally relied on. Therefore, we felt it was important to draw attention to our own findings, which we believe have contributed to understanding this important but sensitive area of workforce research.

References

Lagunes-Cordoba, E, Maitra, R, Dave, S, Matheiken, S, Oyebode, F, O'Hara, J, et al. International medical graduates: how can UK psychiatry do better? BJPsych Bull 2021, 45(5), 299304.CrossRefGoogle Scholar
Tiffin, PA, Orr, J, Paton, LW, Smith, DT, Norcini, JJ. UK nationals who received their medical degrees abroad: selection into, and subsequent performance in postgraduate training: a national data linkage study. BMJ Open 2018; 8: e023060.CrossRefGoogle ScholarPubMed
Tiffin, PA, Paton, LW. Differential attainment in the MRCPsych according to ethnicity and place of qualification between 2013 and 2018: a UK cohort study. Postgrad Med J 2021; 97: 764–76.Google ScholarPubMed
Esmail, A, Roberts, C. Academic performance of ethnic minority candidates and discrimination in the MRCGP examinations between 2010 and 2012: analysis of data. BMJ 2013; 347: f5662.CrossRefGoogle ScholarPubMed
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