LONDON Differential Attainment Resources – Trainers

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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.


We are delighted to share with you a series of resources for educators, produced by experts in their respective fields, to support the learning needs of postgraduate medical trainees. A key theme of these materials is the importance of recognising the individuality of trainees, they are neither a homogenous group nor behave in predictable ways. Therefore, assumptions, stereotypical views and any unconscious biases must be left at the door!

The video introduction by Jacqueline Macdonald-Davis and David Mendel outlines the rationale behind the production of these resources and offers suggestions on how they might be used, either 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, with the chance to get to know your trainee and specifically:

  • To learn about their background, and if the trainee is an International Medical Graduate, to discover what their medical training experience has been like and how will it compare to working in the NHS and
  • To hear about the trainee’s career plans and explore how you can 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.

How the resources are organised:

Module one consists of an introduction to Differential Attainment, the trainee experience, offers suggestions for supporting trainees from different cultural and linguistic backgrounds, and highlights the importance of building good relationships from the beginning.

Module two consists of an exploration of culture clashes and issues of identity and inclusion.

Module three consists of aims which captures good local practises from departmental and institutional perspectives.

Module four consists of an examination of the importance of communication, building relationships, giving feedback and how meaning can be lost in translation. The educator is encouraged to listen, and ask clarifying questions that will lead to a more nuanced understanding of the trainees perspective, from which a learning plan can be co-created, rather than imposed.

Above all, by enhancing educators’ skills, these modules aim to create working environments where trainees from all backgrounds have a rewarding training experience as they progress within the NHS, and which will lead to your organisation being viewed as one of the best places to train and work.

The authors of these modules are happy to facilitate workshops for supervisors/trainers on any of the topics presented, if you would find it helpful.

Jacqueline MacDonald-Davis and Dr Sarah Siddiqui


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, worksheets 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. It is accompanied by 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

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 [50 mins]

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


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. They also reflect on 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]


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 after their trainees had been removed by the Deanery (this video has an 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 its interpretation at recruitment interviews, panels (e.g. ARCP) or other educational meetings.

Links to resources:

Presentation on Interview Insights for IMGs


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] (The reference for the three levels of listening mentioned in this podcast is: Co-Active Coaching, Henry Kimsey-House, Karen Kimsey-House, Phil Sandahl, Laura Whitworth. (First published by Davies-Black Publishing 1998). Nicholas Brealey Publishing (4th edition 2018).)

Key skills – Open Questions and how to use them

Podcast on Open Questions [22mins]


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] (The reference for a way to think about feedback as ‘data’ mentioned in this podcast is: Effective Coaching, Myles Downey, TEXERE, (2003) p83)

Conflict and Mediation

This section offers an introduction to coaching tools and key tips for managing conflict or challenging situations. These worksheets highlight the value in busy and stressful times of bringing compassion to interactions with trainees, while recognising that challenging behaviours can be an indicator of challenges elsewhere in life, and the importance of being ready and willing to listen without judgement. The section also features a podcast with a professional mediator on what mediation is, and when to use it to manage conflict in clinical settings.

Links to resources:

Conflict modes

Bringing Compassion to the table

Podcast on Mediation [38mins]


In this section we introduce Mindfulness, including an audio podcast describing its use in supervision and key tips for deciding when it is appropriate to use with trainees. 

Links to resources:

An introduction to Mindfulness

Podcast on Mindfulness in Supervision [10mins]

Mindfulness Session Audio Clip


Facilitating Conversations (for Trainees)

Written modules around building relationships with your supervisor, including reframing feedback, managing conflict and the importance of compassionate leadership. Listen to our audio podcast which introduces a coaching session focussing on skills for 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 Modes

Introduces trainees to a coaching tool for managing conflicts, exercises to recognise default mode(s) and a 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 find it difficult to ask for help and offers a coaching approach to requesting support.

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 raise a difficult topic with their supervisors and offers 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


London & KSS PSU website

Infographic of PSU Resources

Specialist Clinical Communication and Linguistic Services

The PSU offers a variety of individual and group sessions where trainees have the opportunity to work with clinical educators, linguists and professional role players to develop their spoken and written communication skills in a variety of contexts.

Specialist Clinical Communication & Linguistic Services | London (

Career support and self-coaching material

Resources around making choices about your career could be based on the SCAN model that is: self-awareness, career exploration, making decisions and next steps. There are also links to workshops on consultant interviews and 1:1 confidential, impartial career coaching conversations.

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.