Teaching and mentoring
Ethnicity and Performance in the MRCGP Assessment
Â
A cross-sectional study investigated differential attainment in all UK general practice licensing tests (2016-2021), comparing ethnic minority with White doctors. 3429 doctors of different ethnic groups (White British 53.95%, minority ethnic 43.04%, and mixed 3.01%), country of primary medical qualification (UK 76.76% versus non-UK 23.24%), sex and declared disability, were included.
Ethnic background did not reduce the chance of passing GP licensing tests once sex, place of primary medical qualification, declared disability and Multi-Speciality Recruitment Assessment (MSRA) scores were considered.
Ethnic minority doctors did significantly better compared to White British doctors in the AKT (odds ratio [OR] 2.05, 95% confidence interval [CI] = 1.03 to 4.10, P = 0.042). There were no significant differences on other assessments.
International Medical Graduates (IMGs) performed significantly less well than UK-trained graduates in the CSA, RCA and ARCP, but not the AKT.
Both White (OR 0.19, 95% CI = 0.07 to 0.48, P=0.001) and ethnic minority (OR 0.15, 95% CI=0.08 to 0.30, P<0.001) doctors not graduating in the UK performed significantly less well on the CSA, but this was not the case for ethnic minority doctors graduating in the UK (OR 0.55, 95% CI = 0.28 to 1.09, P = 0.086). Only ethnic minority doctors not graduating in the UK performed significantly less well on the RCA (OR 0.11, 95% CI = 0.03 to 0.45, P=0.002).
Being a White or ethnic minority IMG predicted a significantly lower likelihood of obtaining only standard ARCP outcomes, but this was not the case for ethnic minority UK graduates.
MSRA scores were highly predictive for GP training end-point assessments (AKT, CSA, RCA, WPBA and ARCP).
Suggested WiseGP actions:
GP Registrars who scored low in the MSRA or obtained their primary medical qualification outside the UK, may need additional support during training to maximise their chances of achieving licensing. Does your region ensure fair allocation of more sought-after training practices/ rotations and is any enhanced educational provision offered if needed? (Read more about the possible reasons behind differential attainment in IMGs in the original article).
Scroll down to the next WiseGP GEM, where we discuss a Social Prescribing Scheme Pilot established for IMG GP Registrars in Yorkshire and the Humber. Could your area support a similar scheme to support the holistic wellbeing of your GP Registrars?
Read more about the research informing this GEM:
https://bjgp.org/content/73/729/e284.short
Social Prescribing for IMG GP Registrars
Â
International Medical Graduates (IMGs) experience disproportionally worse outcomes in GP Specialty Training when compared to their peers. Lack of autonomy about the geographical location of work, poor work-life balance, the potential stigma of supplementary help, anxiety about possible exam failure, visa difficulties and costs, may all impact on their training.Â
Â
A Social Prescribing Scheme Pilot was established for IMG GP Registrars in Yorkshire and the Humber. From 33 referrals, 21% of requests were for accommodation issues, 18% for childcare issues and 11% for mental health problems. Feedback from trainees was positive.
Human factors such as accommodation and financial worries can have a huge impact on trainees’ wellbeing and progression.
Â
Suggested WiseGP actions:
Take a holistic approach to enquiring about the wellbeing of GP Registrars, to help identify and support them with human factors such as accommodation and financial worries, which can impact on trainees’ health and progression.
Enquire with TPDs in your region if a similar support scheme could be established for your trainees.
Read more about the research informing this GEM here:
Mentorship for new pharmacists to help develop their generalist skills
NHS England introduced a Structured Medication Review (SMR) service within Primary Care Networks (PCNs), to address problematic polypharmacy, reduce avoidable hospitalisations and deliver better value from medicines spending. New pharmacists who lacked patient-facing expertise were found to draw on pre-existing frameworks and templates, lacking the skills and experience to deliver holistic reviews, meaning opportunities for shared-decision making were potentially missed.
Suggested WiseGP actions:
New pharmacists require support to develop their skills working beyond guidelines and to share decision making with patients before they can deliver effective SMRs. Could they be supported and mentored by pharmacists with more general practice experience within your PCN, or could complex reviews be discussed with a GP mentor initially to facilitate the development of these skills in pharmacists who are new to practice?
Read more about this research here:
https://bjgp.org/content/72/722/e641
Approaches to help prevent GP burnout
Moderate to high GP burnout exists worldwide. To help address this, clinicians need some autonomy over their work, a sense of belonging within their team and to feel they are delivering valued outcomes. There is an overarching need for investment in the workforce to deliver greater numbers of doctors.
Suggested WiseGP actions:
Have a look at our first WiseGP newsletter produced in response to GP burnout- can you identify any changes you could make to help protect yourself and your colleagues? (link)
Examples include promoting patient self-care, reducing sessions or developing a portfolio career, getting appropriate locum cover when indicated, task delegation, innovative use of new PCN team members, helping the duty doctor when they’re struggling and being assertive when declining inappropriate work from secondary care.
Read more about the research informing these recommendations here: https://bjgp.org/content/72/718/e316
