Abstract
The concept of medical professionalism is enshrined in the principles of Good Medical Practice (GMP), upheld by the General Medical Council (GMC), and is applicable to all doctors as well as undergraduate students in the United Kingdom. The principles were conceived, developed and implemented to ensure that the highest standards of medical practice are adhered to for the safety of the public and to retain trust in the medical profession. The GMC has a statutory duty to ensure that professional standards are maintained. Approximately 1% of doctors on the medical register are subject to investigation by the GMC, based on referrals made by employing organisations or the public.
 While appropriate GMC investigation is essential to maintain standards, patient safety and public confidence, there are inherent inequalities in the process resulting in widely different outcomes for certain groups of students or doctors based on Black and minority ethnicity, male gender and non-UK primary medical qualification often leading to devastating consequences.
 This narrative review considers the contributors to differential attainment (DA) and the impact on the health service, patients and individual wellbeing. It explores the tenets of a current narrow definition of professionalism which, while representing the unidimensional White majority view, ignores the huge diversity of the workforce and the public, thus exposing significant tensions for groups of professionals. The Covid-19 pandemic has exposed the inherent systemic bias in the health service for both professionals and the public. This review recommends root and branch reform of the definition of professionalism, by engagement with the public and the workforce, to incorporate principles of equality, diversity and inclusion, which the authors believe will create the environment for a just and equitable professional experience. 1
Highlights
Differential attainment (DA) or outcomes in the medical profession describes the gap in achievement or outcomes between cohorts of doctors based on factors other than their individual actions, ability or academic prowess and is a manifestation of inherent systemic bias or inequalities.[2,3] The evidence to date overwhelmingly demonstrates that within the entire spectrum of the medical profession race, ethnicity, gender, disability and socio-economic factors are prime determinants of DA
We look at DA in the context of medical professionalism, exploring the impact of decisions and judgments made about a doctor’s professional practice by employers and regulators when concerns have been raised about their Fitness to Practise (FtP)
Our analysis shows that doctors who obtained their primary medical qualification outside the UK and those who are from a Black and Minority Ethnic (BME) background are more likely to have formal disciplinary investigations and be referred to the General Medical Council (GMC) with concerns about FtP by their employers and healthcare providers, compared to their UK qualified BME or White peers
Summary
Differential attainment (DA) or outcomes in the medical profession describes the gap in achievement or outcomes between cohorts of doctors based on factors other than their individual actions, ability or academic prowess and is a manifestation of inherent systemic bias or inequalities.[2,3] The evidence to date overwhelmingly demonstrates that within the entire spectrum of the medical profession race, ethnicity, gender, disability and socio-economic factors are prime determinants of DA. That Black and Minority Ethnic (BME) groups are disadvantaged compared to their White counterparts[4], those who trained and qualified overseas and women in career progression as well as pay[5]. There are associations observed about doctors’ gender, countries of origin, primary medical qualifications and ethnicity among others.
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