Bridging the Gap 2021- Summary Report

Abstract

Differential Attainment
 
 Healthcare professionals are among the most respected, valued members in any society- and also the most regulated. It attracts some of the most talented, innovative and resilient individuals who are keen to do good. Respect, job satisfaction and autonomy are fundamental to the experience of any professional, and often valued above financial or material reward. Doctors are no different.
 Education and training of the healthcare workforce is a lengthy and resource intense process. No nation-state can be truly self-sufficient. Hence workforce migration is a reality where various pull and push factors lead to professionals moving across countries and continents, in the service of populations.
 Society is divided along many lines and steeped with structural inequalities. Many of these are the result of thousands of years of history, legacy and societal wrongs. Healthcare services and professionals reflect similar patterns of the 'big society'.
 The phenomenon of differential attainment (DA), which is the subject of this report is simply a manifestation of such structural inequalities. DA or differential outcomes for doctors due to their age, race, gender, sexual orientation, ethnicity, disability, socio-economic deprivation or influenced by migrant status - rather than motivation, ability, effort or enterprise.
 DA is fundamentally unfair. Those affected by DA are either unaware or unable to counteract the influence on their careers. DA leads to demoralisation, disengagement and poor outcomes for professionals and their patients. It takes its toll not only on careers but on lives and livelihoods. DA leads to a huge under-utlisation of human resources- a true waste of talent and enterprise.
 This report- BTG21 focuses on DA in the medical profession exploring the career cycle through the themes of recruitment, assessments, career progression, research & academia, leadership roles, awards and professionalism.
 BTG21 is people-centred and in tackling inequalities offers solutions on career fulfillment and wellbeing- by an ideological shift of hearts and minds.
 
 Thematic Synthesis
 
 BTG21 summary report is the culmination of a thematic synthesis of evidence covering the full spectrum of medical careers. It presents lived experiences (collected through mixed method approaches) capturing patterns in peoples experiences through an online survey, and in-depth qualitative interviews with a purposive sample of professionals from across the career cycle, range of ethnic heritage, medical specialism and country of origin.
 Followed by consensus developed through workshops by a triumvirate of experts, stakeholders and grassroots professionals.
 There are 5 primary causes of DA- bias, social class & deprivation, immigration status, geographical and individual factors and impacts every stage of medical professional careers.
 The thematic synthesis reviews are published in the Sushruta Journal of Health Policy.
 
 Recommendations
 
 The Workshop discussions, recommendations (the 10-point plan) include policy enablers, immediate actions and research questions in the following areas;
 
 
 
 Tackling bias
 Embracing diversity & inclusion
 Celebrating the contribution of migrants
 Leveling the playing field
 Inclusive leadership & accountability
 Removing structural barriers
 Review-Reform-Rethink assessments
 Redefining professionalism
 Disaggregation-intersectionality-benchmarking of data
 Support-flexibility & Wellbeing
 
 
 
 

Inequitable treatment as perceived by international medical graduates (IMGs): a scoping review

“…Where publications had multiple exclusion reasons, the higher-ranked reason on the calibration form was assigned. Three publications presenting amalgamated data were included but extracted only against the explicit IMG voice mentioned within the publications 10 20 21. Two studies presented two publications each 22–25.…”

“…The 33 publications included 3 book/eBook reports1 18 26 and the remaining 30 represented primary academic research publications. Two publications1 10 used various methods including focus groups and written submissions in addition to individual IMG interviews to report findings. One study used two qualitative techniques- focus group interview in addition to a 10-min ‘critical incident’ narrative writing 27.…”

“…On reviewing the aims, objectives and methods of each study report, the majority did not directly seek data related to inequitable treatment or well-being. Inequitable treatment data alone was sought in 6/31 studies20 21 28–31; well-being data were sought in 2/31 studies26 32 and 3 studies sought both items 10 21 22 33…”

“…Exploring concepts of perceived inequitable treatment is important. Not only as a moral obligation to our colleagues, but because discrimination may influence career direction, physical health and well-being 10–12. Therefore, this scoping review aims to explore experiences of workplace-related discrimination, prejudice and bias as reported by IMGs worldwide.…”

As a Person of Colour and a Minority in Britain, is it safe to Speak Up?

“…[5] Analysis of data from cases of professional misconduct among medical professionals demonstrate clearly that minority ethnic doctors or nurses face a disproportionately higher risk of referral to the regulator and receiving harsher sanctions compared to their white peers. [6,7][8] They are frequently passed over for promotion and do not have equity of opportunity and the NHS Workforce Race Equality Standards reports do not show consistent improvement as there is a lack of accountability. [9] No one is free of faults, of making errors of judgement, making unwise choices and certainly the adage, 'to err is human…' is true.…”