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Differential attainment: how can we close the gap in paediatrics?
  1. Laura Kelly1,
  2. Sailesh Sankaranarayanan2
  1. 1Paediatrics, Birmingham Women's and Children's NHS Foundation Trust, Birmingham, Birmingham, UK
  2. 2Postgraduate Medical and Dental Education, Health Education England West Midlands, Edgbaston, Birmingham, UK
  1. Correspondence to Dr Laura Kelly, Paediatrics, Birmingham Women's and Children's NHS Foundation Trust, Birmingham, Birmingham, UK; lkelly9{at}


Differential attainment is the gap in attainment between different demographic groups undertaking the same assessment. Across the UK, we see differences in outcome in undergraduate and postgraduate medical education on the basis of gender, age, ethnicity and country of primary medical qualification which cannot be explained by a difference in ability. The largest gaps appear when we look at the variation in outcome between UK and international medical graduates (IMGs) and between white British and black, Asian and minority ethnic (BAME) doctors in postgraduate medical education. If we look to postgraduate medical examinations, the differences in attainment are stark and occur across all medical specialties, with paediatrics being no exception. The differences are also seen in the rates of relative success in recruitment to training posts and in a trainee’s likelihood of getting a satisfactory outcome at the Annual Review of Competence Progression. Ensuring all doctors reach their full potential is undoubtedly an issue of fairness that is of particular significance to paediatrics as IMGs make up 47% of our medical workforce and 36% of the paediatric workforce identifies as being from a BAME group. It is clear that if we fail to close the gap in differential attainment, there will be both a personal cost to affected individuals, but also a cost to the wider paediatric profession and the children they serve. This paper hopes to summarise the background and causes to differential attainment and look towards possible interventions that might tackle this issue.

  • ethics
  • health services research
  • qualitative research

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  • Twitter @lauraamkelly

  • Contributors LK wrote the article and SS provided supervision.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Provenance and peer review Commissioned; externally peer reviewed.