Rapid responses are electronic comments to the editor. They enable our users
to debate issues raised in articles published on bmj.com. A rapid response
is first posted online. If you need the URL (web address) of an individual
response, simply click on the response headline and copy the URL from the
browser window. A proportion of responses will, after editing, be published
online and in the print journal as letters, which are indexed in PubMed.
Rapid responses are not indexed in PubMed and they are not journal articles.
The BMJ reserves the right to remove responses which are being
wilfully misrepresented as published articles or when it is brought to our
attention that a response spreads misinformation.
From March 2022, the word limit for rapid responses will be 600 words not
including references and author details. We will no longer post responses
that exceed this limit.
The word limit for letters selected from posted responses remains 300 words.
We read Majid’s article with great interest. It draws attention to the enduring disparities in academic and professional outcomes among UK doctors, particularly international medical graduates (IMGs), compared to their white, UK-trained peers. Though progress has been made in addressing differential attainment at the professional level, recent data from the 2024 GMC National Training Survey point out continued concerns among doctors.(1)
Insights from global educational initiatives suggest that inequity in performance often reflects underlying differences in training exposure and resource availability. In a UK-based simulation-based learning programme, participants from both high-income (HICs) and Low- to middle-income countries (LMICs) reported universally positive experiences. However, those from LMICs reported more tangible improvements in their clinical decision-making and patient care practices.(2) Interestingly, in a follow-up analysis involving 289 learners from 49 countries, significant disparities were observed between participants from HICs and LMICs, particularly in domains such as clinical judgment and management. Smaller but consistent gaps were noted in history-taking and interpretation of investigations. Since most IMGs come from such LMICs, the findings can be extrapolated to their experiences in their initial months in the UK. This highlights the case for early, structured, and equitable educational interventions tailored to empower these individuals, minimise avoidable variation in care, and help foster equitable patient outcomes across the system.
Moving forward, a shift is needed from passive knowledge delivery to dynamic, learner-centred models that prioritise accessibility, adaptability, and inclusivity. While no single intervention will eliminate all the structural drivers of differential attainment, a growing body of evidence points to the value of simulation-based and personalised learning environments. Integrating these principles into both undergraduate and postgraduate medical education could represent a practical and sustainable step toward levelling the playing field for all UK doctors.
2. Malhotra K, Ali A, Soran V, Ogiliev T, Zhou D, Melson E, Davitadze M; Kempegowda P. Levelling the learning ground for healthcare professionals across the world through simulation: a mixed-methods study. BMJ Open. 2023;13(7):e069109. doi:10.1136/bmjopen-2022-069109
Competing interests:
No competing interests
10 May 2025
Harshin P Balakrishnan
Contingent Worker
Punith Kempegowda
Department of Applied Health Sciences, College of Medical and Dental Sciences, University of Birmingham, Birmingham, United Kingdom
Re: Differential attainment: struggling to move the dial
Dear Editor,
We read Majid’s article with great interest. It draws attention to the enduring disparities in academic and professional outcomes among UK doctors, particularly international medical graduates (IMGs), compared to their white, UK-trained peers. Though progress has been made in addressing differential attainment at the professional level, recent data from the 2024 GMC National Training Survey point out continued concerns among doctors.(1)
Insights from global educational initiatives suggest that inequity in performance often reflects underlying differences in training exposure and resource availability. In a UK-based simulation-based learning programme, participants from both high-income (HICs) and Low- to middle-income countries (LMICs) reported universally positive experiences. However, those from LMICs reported more tangible improvements in their clinical decision-making and patient care practices.(2) Interestingly, in a follow-up analysis involving 289 learners from 49 countries, significant disparities were observed between participants from HICs and LMICs, particularly in domains such as clinical judgment and management. Smaller but consistent gaps were noted in history-taking and interpretation of investigations. Since most IMGs come from such LMICs, the findings can be extrapolated to their experiences in their initial months in the UK. This highlights the case for early, structured, and equitable educational interventions tailored to empower these individuals, minimise avoidable variation in care, and help foster equitable patient outcomes across the system.
Moving forward, a shift is needed from passive knowledge delivery to dynamic, learner-centred models that prioritise accessibility, adaptability, and inclusivity. While no single intervention will eliminate all the structural drivers of differential attainment, a growing body of evidence points to the value of simulation-based and personalised learning environments. Integrating these principles into both undergraduate and postgraduate medical education could represent a practical and sustainable step toward levelling the playing field for all UK doctors.
References:
1. General Medical Council. Equality, diversity, and inclusion: Targets, progress and priorities for 2024. https://www.gmc-uk.org/-/media/documents/equality-diversity-and-inclusio...
2. Malhotra K, Ali A, Soran V, Ogiliev T, Zhou D, Melson E, Davitadze M; Kempegowda P. Levelling the learning ground for healthcare professionals across the world through simulation: a mixed-methods study. BMJ Open. 2023;13(7):e069109. doi:10.1136/bmjopen-2022-069109
Competing interests: No competing interests