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Exploring the 'award gap' between international medical graduates and UK medical graduates in general practice training

International medical graduates (IMGs) currently account for 41% of the UK medical workforce. IMGs in training posts face challenges in progression including a significant ‘award gap’ (previously differential attainment) in postgraduate training compared to UK medical graduates. General practice (GP) is disproportionately impacted by these issues in progression as over 50% of GP trainees are IMGs. Previous studies have focused on educational interventions to reduce the award gap but have failed to improve training outcomes.This DPhil project aims to increase understanding of the mechanisms underlying the award gap and the potential impacts for patients and the public.

Lead investigator: Dr Laura Emery

Supervisory team: Dr Sophie Park, Dr Eleanor Hoverd, Dr Geoff Wong

Workforce and Learning Research group

 

Patient and Public Involvement (PPI)

PPI has been sought from the outset of this project. Meetings were held with a PPI group to develop the DPhil application, and to define the research question. A project specific PPI group has been established for the project. Meetings are planned at quarterly intervals at the project progresses.

 

Work Package 1: Scoping review

Exploring the literature on the award gap between international and UK medical graduates in general practice training: A scoping review

Aim: To identify literature addressing the factors underlying the award gap.

Progress: Protocol published, searches completed, screening underway, results expected April 2026

 

Work Package 2: Realist review

Wasting the potential to improve access?: A realist review of the 'award gap' between international medical graduates and UK medical graduates in general practice training

Aim: To explore the phenomenon of the ‘award gap’ existing between international medical graduates (IMGs) and UK medical graduates in general practice training. We will consider the mechanisms underlying the award gap, how context influences these mechanisms, and the impacts for patients and the public.

Progress: Submitted to PROSPERO awaiting publication, searches in progress

 

Work Package 3: Realist evaluation

Title and aims to be defined following the realist review

Progress: Preparatory work underway as detailed below

A cycle of educational deprivation?: A quantitative analysis of general practice training placements of international medical graduates

Aim: To establish whether there are differences in the settings in which international medical graduates undertake their GP training placements compared to UK medical graduates; considering factors such as level of deprivation and rurality. The findings will be used to inform sampling across a range of contexts for realist evaluation.