Summary of risk factors and vulnerability processes taken from ‘fair training pathways for all’, Woolf K et al, 2016
| Risk factors and vulnerability processes affecting both BAME and IMG doctors | Risk factors and vulnerability processes particularly affecting IMGs |
| Poorer relationships with seniors and problems ‘fitting in’ at work can lead to fewer learning opportunities, lower confidence and increased chance of mental health problems. | Inexperience with UK assessments, recruitment, UK cultural norms including communication and National Health Service/work systems. |
| Perception that unconscious bias in recruitment, ARCPs, and at work can lead to poorer outcomes, as can anxiety about potential bias. | Cultural differences can impede relationships with colleagues and potentially patients, because of unfamiliarity with UK cultural norms, a feeling of not being understood by UKGs and because trainers can lack confidence in IMGs’ prior training. |
| Poorer performance in exams and recruitment can mean less autonomy in job choice, increased likelihood of being separated from family and support networks, and increased chance of mental health problems. Failing exams can lower confidence and resits can be felt to interfere with workplace learning. | Lengthy time to learn cultural norms. |
| Potential stigma of supplementary help. | |
| Fear of being labelled as problematic can impede trainees reporting problems, including perceived racism. | Anxiety about increased probability of exam failure. |
| Potential for lack of recognition from trainers about environmental stressors, especially because within medicine there is a belief that failure results from lack of motivation or ability. | Visa difficulties and costs, and ineligibility for jobs can reduce training opportunities. |
ARCP, Annual Review of Competence Progression; BAME, black, Asian and minority ethnic; IMG, international medical graduate; UKG, UK graduate.