Experience of Differential Attainment in Psychiatry Trainees at Surrey and Borders Partnership NHS Foundation Trust (SABP)

Aims Differential attainment is a term used to describe variation in the achievement of groups of doctors based on certain characteristics. Evidence suggests that international medical graduates (IMGs) in the UK struggle at different stages of training in many specialties including psychiatry. This project aims to explore the experience of psychiatry trainee doctors and their trainers at SABP to understand this issue and identify areas for quality improvement. Methods This was an exploratory study using a mixed methods approach. Qualitative data were collected via semi-structured interviews and focus groups conducted with trainees and trainers. Interviews and focus groups were recorded and transcribed, then analysed for themes. Quantitative data were collected via an online survey sent to trainees and trainers and were analysed using descriptive statistics. Informed consent was obtained from all participants. This project received approval from the Health Education England research governance committee and was conducted in accordance with British Educational Research Association (BERA) guidelines. Results The online survey had a good response rate of 60.4% for trainees (26 out of total 43 trainees) and 64.7% for trainers (22 out of total 34 trainers). Challenges identified by the participants both in qualitative and quantitative data mirrored the national picture. Five main themes that were identified from semi-structured interviews and focus groups were: 1) the impact of professional and informal support, 2) challenges faced by IMGs in adjusting to the new system, 3) communication barriers, 4) Stress and burnout impacting trainees’ performance and 5) unconscious bias during recruitment, exams, and ARCP on the training experience of IMGs. Conclusion This project was used to generate ideas for quality improvement with regard to the experience of trainees and the reduction of differential attainment within the trust. Findings from this research have guided SABP in the development of interventions to support IMGs and trainers, particularly regarding professional and non-professional support. These interventions include an induction booklet for doctors joining the trust, an IMG support network, and a mentorship scheme for all the trainees. We aim to explore the experience of IMGs trainees and trainers using a similar method in the future to evaluate the success of these interventions. Our findings will have an impact on other organisations providing postgraduate training in psychiatry and other specialties.