Understanding differential attainment in UK postgraduate medical education: a qualitative systematic review based on ethnicity and international medical graduate status

Differential attainment in medical education continues to disproportionately affect international medical graduates (IMGs) and trainees from ethnic minority background in the UK. Despite their vital role in the workforce, these groups encounter lower postgraduate exam pass rates, higher complaints, and slower career progression. This systematic review synthesised qualitative literature published since 2015 to explore the lived experiences and barriers to attainment. Adhering to PRISMA guidelines, six databases were searched, and findings from 33 studies were analysed using a macro-meso-micro framework. Six themes emerged: language and communication barriers, adaptation to UK clinical practices, cultural and social integration struggles, bias in assessments, discrimination, and work-life balance pressures. These reflect the interplay of systemic, organisational, and individual factors contributing to inequities. A conceptual model is presented to demonstrate these dynamics. This review underscores the need for cultural orientation programs, inclusive assessments, and institutional support to promote equity in medical education.