Differential Attainment Resources

Contributor Profiles

Jacqueline Macdonald-Davis MSc, PGCE.

Jacqueline is a qualified teacher and a trained Careers Education and Guidance specialist and has worked in higher education as a lecturer, a consultant and as Head of Staff and Organisational Development at University College London, Institute of Education.

Jacqueline is a trained mentor, coach, and mediator as well as a Myers Briggs assessor. She is the author of several articles and publications. Jacqueline coordinated and oversaw the editing of HEE’s Differential Attainment (DA) Toolkit and the E-Learning, Support and Self-Review Modules. Her passion is to empower individuals to take the ‘next step’ in their personal and professional development. Jacqueline co-ordinated the development of the resources in the KSS Differential Attainment Project and is a member of the London DA Strategy Group.

Dr Sarah Siddiqui

Sarah Siddiqui is a Differential Attainment Fellow in the Professional Development Team in London and South-East who has co-led the development of the resources in the KSS Differential Attainment Project. She is dual-qualified in Medicine and Dentistry, on sabbatical from surgical training and former National Supported Return to Training Fellow for HEE. She has an interest in teaching and in producing educational material and courses around medical training, wellbeing and diversity and inclusion.

Dr Rupal Shah

Rupal Shah (MA (dist) FRCGP) is a GP and trainer in Battersea. She is also an Associate Dean working in the Professional Development Team in London, supporting trainees and supervisors who have faced difficulty. She has published extensively on various educational topics, including DA and has contributed to the DA web resources available in London. She is a member of the London DA Strategy Group.

Dr Helen Halpern

Helen Halpern is an Associate Dean with a background in General Practice and GP training. She has a Master’s degree in Systemic Family Therapy and has the Institute of Leadership Management Certificate in Executive Coaching. She has worked for a number of years in faculty development and in supporting postgraduate doctors in training who find

themselves in difficult situations. Helen has a particular interest in the concept of change and how this can be facilitated through conversations and questions.

Lynne Rustecki

Lynne Rustecki is the Education Lead for Specialist Communication and Linguistic Support in the Professional Support Unit, Professional Development Team for Health Education England. She has a special interest in the communication challenges faced by doctors who are non-native speakers of English, and how linguistic and cultural factors may impact on professional interaction and consequently on Differential Attainment.

Hazel Russo

Hazel Russo is a Professional Support Unit (PSU) Coach, a Coach Supervisor, Facilitator and Trainer with over 20 years’ experience. She also trains and supports healthcare professionals to maintain professional boundaries, probity and ethics following conduct issues (with The Professional Boundaries Company). Hazel has a private coaching practice and is creator of the coaching board game, Lumination®. Hazel specialises in supporting professionals to improve communication, relationships and performance.

We would like to extend a special thank you to all the Supervisors and doctors in training who have contributed to the training package.

As well as the following

Jasveen Kaur Saund

Jasveen is the Business Support Officer for the London and KSS Differential Attainment project.

Femi Adedeji

Femi is the Communication and Engagement Manager for South East England – Responsible for overseeing the KSS podcasts, PDFs and videos.

Harrison Davis

Harrison is the KSS Education Programme Manager – Responsible for overseeing the collation of this resource on the KSS website.

Tamba Sumana

Tamba is the Communications and Engagement Administrator for South East England – Responsible for the podcast transcripts.

Sandrine Massacdo

Sandrine Massacdo led the first phase of the administration of the KSS Differential Attainment Project.

Trainers

We are delighted to share with you a series of resources, produced by experts in their respective fields, for educators to support the learning needs of postgraduate medical trainees. These resources highlight the importance of recognising the individuality of Trainees, that they are neither a homogenous group nor individuals whereby one can predict how they will behave. Therefore, assumptions, stereotypical views and any unconscious biases must be left at the door!

The video introduction by Ms Fiona O’Sullivan and Professor Graeme Dewhurst outlines the rationale behind the production of these resources as well as how they might be used. The materials can be used as a personal stand-alone resource or in a group setting, several of them are interactive and all, invite you to reflect on your professional practice. As a group exercise they could be used in department meetings, as an away-day activity, or as part of action learning sets.

We would like to stress the importance of the induction programme and the initial one-to-one meeting that Educators have with their Trainees. These spaces provide you, as the Trainer, the chance to get to know your Trainee, about their background, and if an International Medical Graduate, what has their medical training experience been like and how will it compare to working in the NHS, what are their career plans and how can you help them to achieve their professional goals. By sharing expectations, the trainee will feel confident to seek you out when things go wrong; making it far easier to have those often-challenging conversations.

In the first module we introduce Differential Attainment, the trainee experience, how to support trainees from different cultural and linguistic backgrounds, and the importance of building good relationships from the beginning. Module two, explores culture clashes and the importance of identity and inclusion, module three, aims to capture good local practices from departmental and institutional perspectives. Module four, examines the importance of communication, building relationships, giving feedback and how words can be lost in translation. The role of the Educator is to listen, to understand, rather than to simply respond, asking questions to seek clarification, can bring about change in attitude and behaviour.

Above all, these modules aim to create working environments (through your personal learning) where trainees from all backgrounds have a good training experience within the NHS, where your organisation is viewed as the best place to train and work.

Jacqueline MacDonald-Davis and Dr Sarah Siddiqui

MODULE 1: AN INTRODUCTION TO DIFFERENTIAL ATTAINMENT

In this module we introduce Differential Attainment in postgraduate medical training and the perspectives of International Medical Graduates.

1.1 An Introduction to Differential Attainment

A recorded lecture presented by Dr Rupal Shah introducing the definition and causes of differing levels of attainment amongst trainees along with PowerPoint slides, work sheet and suggestions for additional reading.

Links to resources:

An Overview of Differential Attainment [31mins]

Presentation Slides

1.2 Developing skills in supervising trainees from diverse cultural & linguistic backgrounds

Culture and Professionalism

In this section we introduce a video where International Medical Graduates and Educators discuss the challenges of adjusting to UK practice and is accompanied with a worksheet with questions and exercises to work through before and after viewing the video. Following this is a presentation introducing the concept of linguistic and social capital, implications of this for DA and ideas for supporting trainees from diverse linguistic backgrounds. Finally, we also have case studies/vignettes for individual or group discussion, with supporting notes to guide the discussion.

Links to resources:

PSU podcast on Culture and Professionalism [8mins] & Accompanying Worksheet worksheet

Supporting doctors from diverse linguistic and cultural backgrounds

Case Studies on Culture Professionalism & Additional discussion notes

Perspectives of working in the NHS as an International Medical Graduate

This audio podcast captures experiences of an International Medical graduate and the insights of an educational supervisor who supports those new to the NHS.

Podcast on Trainee and Educator perspectives on working in the NHS as an IMG [50mins]

Worksheet to accompany the IMG experience Podcast

1.3 Facilitating Conversations with Trainees

In this section we introduce a couple of exercises on the importance of effective communication with trainees from the beginning by building relationships and challenging assumptions.

Links to resources:

Begin well and carry on

Starting with a blank sheet

MODULE 2: AN ADVANCED UNDERSTANDING OF DIFFERENTIAL ATTAINMENT

Identity and Inclusion

In our Identity and Inclusion video, we outline the experience of doctors commencing work in the NHS for the first time or returning to training.

Links to resources:

Identity & Inclusion Video [13mins] & Accompanying worksheet

Culture Clash

We also speak to Educator Dr Amit Gupta on the impact of the complex interplay of culture, environment, work practices and bias on performance of BAME doctors. In the second podcast he describes the impact of racism and how it affects behaviour from a doctor’s perspective.

Culture Clash – Part 1 – an educational supervisors’ perspective and experiences as an IMG [15mins]

Culture Clash – Part 2 – Microbumps – How racism works and affects behaviour – a doctor’s perspective [9mins]

Accompanying worksheet

Capturing Good Educational Practice: Targeted Training for GP trainees

In these videos, Dr Rupal Shah is in discussion with Dr Smart Onukaogu and Dr Rob Gardiner about the challenges of progressing in training, and their experiences of overcoming the attainment gap in GP training and personal circumstances, the support they received and how appreciative enquiry can support trainees to overcome challenges.

Links to resources:

Capturing good practice – In discussion with GP trainee Dr Smart Onukaogu [16mins24s]

Capturing good practice – In discussion with GP trainee Dr Rob Gardiner [14mins22s]

MODULE 3: DEPARTMENTAL AND INSTITUTIONAL APPROACH TO DA

Institutional Approach to IMG Recruitment & Induction

In this section we explore the support available to IMGs who are new to the NHS in Kent, Surrey and Sussex. We also include a report of how a trust changed recruitment policy and methods creating a Trust Grade Foundation Programme for IMGs

Links to resources:

Initial support available to IMGs new to the NHS in KSS

Junior Trust Grade Foundation Program at the Royal Surrey Hospital

Capturing Good Practice: North Middlesex Anaesthetic Department experience

In this short video we are in conversation with Dr Alice Fungwah Man learning from a department’s experience of measures taken to improve training once they had their trainees removed by the deanery (with accompanying question worksheet)

Links to resources:

Capturing good Practice Video – In discussion with Alice Funwah Man from North Middlesex [9mins18s] Accompanying worksheet

Capturing Good Practice: Institutional Perspectives

In this videocast we capture the work done on Race & Privilege at the East London Foundation Trust.

Links to resources:

Capturing good practice – innovations at the East London Foundation Trust [33mins]

Language and Inclusion in Interview Settings

The use of language and it’s interpretation at recruitment interviews, panels (e.g. ARCP) or other educational meetings.

Links to resources:

Presentation on Interview Insights for IMGs

MODULE 4: KEY AND ADVANCED COMMUNICATION SKILLS FOR SUPERVISION

In this module we include a directory of bite sized worksheets developed by a communications coach around effective communication with trainees including key skills, building relationships, giving effective feedback, conflict and mediation.

Coaching Tools for Supervision

In this section we explore modules on using coaching techniques to support trainees with motivation, confidence, and commitment.

Links to resources:

Growth Mindset – the basics

Start with what’s working – Appreciative Enquiry

Scaling 1 – 10 to build motivation, confidence, and commitment

Coaching for success – T-GROW

Key Skills for Communication

In this section, the key skills worksheet introduces Three Levels of Listening and the power of listening to support change. In the podcast on listening, we describe the Three Levels of Listening, followed by demonstrations of Level 1 listening and Level 2 and 3 Listening (active and intuitive listening) and how good listening can impact differential attainment

The key skills worksheet introduces a coaching approach to open questions and how to use them to build relationships with trainees and support motivation. In the podcast we introduce the use of open questions and demonstrate a trainee and supervisor interaction firstly using closed questions, followed a demonstration using open questions. We discuss the benefit of open questions to the trainer-trainee relationship.

Links to resources:

Key skills – Listening

Podcast on Listening [24mins]

Key skills – Open Questions and how to use them

Podcast on Opening Questioning [22mins]

Feedback

Introducing coaching tools for reframing feedback, exercises to use with a trainee in mind and a podcast discussing and demonstrating ineffective and effective feedback techniques. In the podcast we highlight the importance of providing early feedback and in a way that encourages further discussion and exploration with the trainee.

Links to resources:

Feedback Tips & Tools

Podcast on Providing Feedback [25mins]

Conflict and Mediation

Introduction coaching tools and key tips for managing conflict or challenging situations and when it is important to bring compassion to the table. These worksheets highlight the value in busy and stressful times of bringing compassion to interactions with trainees, introduces recognition that challenging behaviours can be an indicator of challenges elsewhere in life, and the important of being ready and willing to listen without judgement. Also featuring a podcast with a professional mediator on what is mediation, when to use it to manage conflict in clinical settings.

Links to resources:

Conflict modes

Bringing Compassion to the table

Podcast on Mediation [38mins]

Mindfulness

In this section we introduce the Mindfulness, including an audio podcast describing the use of mindfulness in supervision and key tips for situations when it is appropriate to use with trainees. There is also an audio clip of a mindful moment session for use with trainees.

Links to resources:

An introduction to Mindfulness

Podcast on Mindfulness in Supervision [10mins]

Mindfulness Session Audio Clip

MODULE 5: RESOURCES FOR TRAINEES

Facilitating Conversations (for Trainees)

Written modules around building relationships with your supervisor, reframing feedback and managing conflict and the importance of compassionate leadership. Listen to our audio podcasts which introduces a coaching session on opening a challenging conversation with your trainer and how to ask for help.

Links to resources:

Building a good relationship with your trainer

Tips for trainees on how to build good relationships with trainers and why that is useful.

Feedback – tips and tools

Reframing feedback for trainees, introduction to models for giving and receiving feedback, with examples and exercises on how to give feedback and respond to feedback received.

Conflict Mode

Introducing trainees to a coaching tool for managing conflicts, exercises to recognise default mode(s) and simple exercise on how to work with it.

Bringing compassion to the table

Highlighting the evidence for and value of bringing compassion to interactions with patients and references also to compassionate leadership.

Audio Podcast on Asking for Help

In this podcast coach Hazel Russo discusses with Dr Sarah Siddiqui the dynamics around why trainees finding it difficult to ask for help and offers a coaching approach to asking for help.

Audio Podcast on Approaching a Challenging Conversation with a Supervisor

In this podcast coach Hazel Russo explores with Dr Sarah Siddiqui the reasons why trainees might find it difficult to approach a challenging conversation or a conversation around a difficult topic with their supervisors and some coaching approaches and tips about how to make the process easier.

Portfolio and ARCP Preparation

A presentation around portfolio working, perspectives around reflective learning and preparing for an ARCP.

Links to resources:

ARCP Preparation Slide set Tips

Tools for Preparation for ARCP

Preparation for Postgraduate Exams

A presentation on preparation for postgraduate exams and re-sits with tips around revision, exam technique and additional support available.

Links to resources:

How to prepare for Postgraduate Medical Exams Presentation

How to prepare to Resit Postgraduate Exams Presentation

MODULE 6. ADDITIONAL SUPPORT AND RESOURCES

Professional Support Unit Services

London & KSS PSU website

Infographic of PSU Resources

Career Support and self-coaching material

Resources around making choices about your career based on SCAN model animation and exercises relating to self-awareness, career exploration, making decisions and next steps, along with links to our workshops on consultant interview and 1:1 confidential, impartial career coaching conversations with trainee doctors at any level to explore opportunities and to address career progression concerns.

Links to resources:

SCAN Career Planning Model

A structured framework designed to offer informed, realistic and robust career planning for health professionals

Networking For Clinicians

This webinar focuses on the advantages of utilising and developing a network of key contacts to inform conversations around your career and clarify understanding of particular roles and opportunities

Confidential 1:1 Careers Support

The Careers Unit provides free and confidential individual support and coaching to doctors and dentists training in London and KSS. If you wish to discuss how best to manage your career, the careers team can assist you to explore your options. Apply here

E-learning, Support and Self-Review Modules

E-learning, Support and Self-Review Modules, including: Assertiveness, Insight, Stress, Mental Health and Wellbeing, Resilience, Examination Support, Personal and Professional Effectiveness including Time Management.

Differential Attainment and Disability

Disabled Doctors Network

Support Groups for Health Professionals

One-to-one support

Other Resources

Key links and Exercises including, breaking unwelcome news, Counselling and Support, Disabilities, Equal Opportunities, Learning and Development, Managing Anxiety, Mental Health, Mindfulness and Stress, Burnout and Vicarious Traumatisation (VT)

Virtual Group Support for Trainees

Other Useful Resources

BMA: Sources of support for your wellbeing

Help me, I’m a doctor

TEDTalks provide interesting talks on subjects such as, confidence building, resilience, managing stress and well-being.

Assertiveness

Trainees

The resource package has been developed by the Professional Support Unit (PSU) in London for the Kent, Sussex and Surrey Postgraduate School as a compilation of written, audio and video resources produced by experts in their respective fields, to support the learning needs of a diverse workforce and to provide trainees with the tools to navigate postgraduate training.

In the first chapter we introduce Differential Attainment (DA), the perspectives of trainees from different cultural and linguistic backgrounds and explore the importance of identity and inclusion and effects of culture clash. Chapter two explores communication, the importance of building good relationships from the beginning, receiving feedback, and approaches, this chapter also captures good local practices from departmental and institutional perspectives. Chapter three provides resources for career progression including preparing for exams, work-based assessments, ARCPs and other high stakes interviews. The final chapter outlines additional support and resources from the PSU.

These resources aim to demonstrate trainees are not a homogenous group, but individuals with different learning needs. We hope they help to provide a good training experience.

MODULE 1: AN INTRODUCTION TO DIFFERENTIAL ATTAINMENT

A recorded lecture presented by Dr Rupal Shah introducing Differential Attainment in postgraduate medical training and causes of differing levels of attainment amongst trainees along with suggestions for additional reading.

Links to resources:

An Overview of Differential Attainment (Slides)

An Overview of Differential Attainment (video)

1.2 Perspectives on Differential Attainment

1.2.1 Identity and Inclusion

In our Identity and Inclusion video, we outline the experience of doctors commencing work in the NHS for the first time or returning to training. We also speak to Educator Dr Amit Gupta on the impact of the complex interplay of culture, environment, work practices and bias on performance of BAME doctors. In the second podcast he describes the impact of racism and how it affects behaviour from a doctor’s perspective.

Links to resources: Identity & Inclusion Video [13mins] & Accompanying worksheet

Culture Clash – Part 1 – an educational supervisors’ perspective and experiences as an IMG [15mins]

Culture Clash – Part 2 – Microbumps – How racism works and affects behaviour – a doctor’s perspective [9mins]

1.2.2 Perspectives of working in the NHS as an International Medical Graduate

This audio podcast captures experiences of an International Medical graduate and the insights of an educational supervisor who supports those new to the NHS.

Links to resources:

Podcast on Trainee and Educator perspectives on working in the NHS as an IMG [50mins]

1.2.3 Culture and Professionalism

In this section we introduce a video where International Medical Graduates and Educators discuss the challenges of adjusting to UK practice and is accompanied with a worksheet with questions and exercises to work through before and after viewing the video.

Links to resources:

PSU podcast on Culture and Professionalism [8mins] & Accompanying worksheet

1.3 Capturing and learning from good educational practice

1.3.1 Capturing Good Educational Practice – Targeted Training for GP trainees

In these videos, Dr Rupal Shah is in discussion with Dr Smart Onukaogu and Dr Rob Gardiner about the challenges of progressing in training, and their experiences of overcoming the attainment gap in GP training and personal circumstances, the support they received and how appreciative enquiry can support trainees to overcome challenges.

Links to resources:

Capturing good practice – In discussion with GP trainee Dr Smart Onukaogu [16mins24s]

Capturing good practice – In discussion with GP trainee Dr Rob Gardiner [14mins22s]

1.3.2 Capturing Good Practice: Institutional Perspectives

This videocast captures the work on race and privilege at East London Foundation Trust. A report of how a trust changed recruitment policy and methods creating a Trust Grade Foundation Programme for IMGs demonstrates how equity can be achieved at local levels.

Links to resources:

Capturing good practice – innovations at the East London Foundation Trust [33mins]

Junior Trust Grade Foundation Program at the Royal Surrey Hospital

MODULE 2. COMMUNICATION BETWEEN TRAINEES & EDUCATORS

2.1 Facilitating Conversations with Supervisors

These worksheets introduce approaches to building relationships with your supervisor, reframing feedback and compassionate leadership. The audio podcasts frame a coaching approach to asking for help and opening challenging conversations with your supervisors.

Links to resources:

Building a good relationship with your trainer

Tips for trainees on how to build good relationships with trainers and why that is useful.

Feedback – tips and tools

Reframing feedback for trainees, introduction to models for giving and receiving feedback, with examples and exercises on how to give feedback and respond to feedback received.

Bringing compassion to the table

Highlighting the evidence for and value of bringing compassion to interactions with patients and references also to compassionate leadership.

Audio Podcast on Asking for Help

In this podcast coach Hazel Russo discusses with Dr Sarah Siddiqui the dynamics around why trainees finding it difficult to ask for help and offers a coaching approach to asking for help.

Audio Podcast on Approaching a Challenging Conversation with a Supervisor

In this podcast coach Hazel Russo explores with Dr Sarah Siddiqui the reasons why trainees might find it difficult to approach a challenging conversation or a conversation around a difficult topic with their supervisors and some coaching approaches and tips about how to make the process easier.

2.2 Conflict and Mediation

Introducing a coaching tool for trainees in managing conflict or challenging situations with exercises to recognise default mode(s) and on how to work with it. Also featuring a podcast with a professional mediator on what is mediation, when to use it and when to avoid.

Links to resources:

Conflict Mode

Podcast on Mediation [38mins]

Mindfulness

In this section we introduce the Mindfulness, including an audio podcast describing the use of mindfulness in supervision and key tips for situations when it is appropriate to use with trainees. There is also an audio clip of a mindful moment session for use with trainees.

Links to resources:

An introduction to Mindfulness

Podcast on Mindfulness in Supervision [10mins]

Mindfulness Session Audio Clip

2.3 Doctors from diverse linguistic and cultural backgrounds

In this presentation we introduce the concept of linguistic and social capital, implications of this for DA.

Links to resources: Supporting doctors from diverse linguistic and cultural backgrounds

MODULE 3. RESOURCES FOR PROGRESSION IN TRAINING

3.1 Portfolio and ARCP Preparation

A presentation on portfolio working, perspectives around reflective learning and preparing for an ARCP and common pitfalls. A recorded presentation highlighting the use of language and it’s interpretation at recruitment interviews, panels (e.g. ARCP) or other educational meetings.

Links to resources:

ARCP Preparation Slide set

Presentation on Language and Inclusion in Interview Insights for IMGs

Tips and Tools for Preparation for ARCP

3.2 Preparation for Postgraduate Exams

A presentation on preparation for postgraduate exams and re-sits with tips around revision, exam technique and additional support available.

Links to resources:

How to prepare for Postgraduate Medical Exams Presentation

How to prepare to Resit Postgraduate Exams Presentation

3.3 Career Support and self-coaching material

Resources around making choices about your career based on SCAN model animation and exercises relating to self-awareness, career exploration, making decisions and next steps, along with links to our workshops on consultant interview and 1:1 confidential, impartial career coaching conversations with trainee doctors at any level to explore opportunities and to address career progression concerns.

Links to resources:

SCAN Career Planning Model

A structured framework designed to offer informed, realistic and robust career planning for health professionals

Networking For Clinicians

This webinar focuses on the advantages of utilising and developing a network of key contacts to inform conversations around your career and clarify understanding of particular roles and opportunities.

Confidential 1:1 Careers Support

The Careers Unit provides free and confidential individual support and coaching to doctors and dentists training in London and KSS. If you wish to discuss how best to manage your career, the careers team can assist you to explore your options. Apply here

MODULE 4. ADDITIONAL SUPPORT AND RESOURCES

4.1 Professional Support Unit Services

London & KSS PSU website & Infographic of PSU Resources

4.2 E-learning, Support and Self-Review Modules

E-learning, Support and Self-Review Modules, including: Assertiveness, Insight, Stress, Mental Health and Wellbeing, Resilience, Examination Support, Personal and Professional Effectiveness including Time Management.

4.3 Online resources from PSU

Key links and Exercises including, breaking unwelcome news, Counselling and Support, Disabilities, Equal Opportunities, Learning and Development, Managing Anxiety, Mental Health, Mindfulness and Stress, Burnout and Vicarious Traumatisation (VT)

Virtual Group Support for Trainees

4.4 Other Useful Resources

BMA: Sources of support for your wellbeing

Help me, I’m a doctor

TEDTalks provide interesting talks on subjects such as, confidence building, resilience, managing stress and well-being.

Assertiveness

4.5 Differential Attainment and Disability

Disabled Doctors Network

Support Groups for Health Professionals

One-to-one support