title: Access, Experience and Outcomes Among Diverse Groups Nationally from Classroom to Clinic
title: The Gini Factor in Medical Education
titleType: Subtitle
Creators: name: Soltan, Marina
Publisher: name: Lancaster University
Year: 2025

description: This thesis explores access, experience, and outcomes from GP Higher
 Specialist Training (GPHST), the largest UK speciality training programme,
 among diverse groups through equalities lenses solely and
 intersectionally: age, sex, socioeconomic status, ethnicity, disability,
 religion, sexual orientation. Three
 
 quantitative cohort studies are presented using UK Medical Education
 Database (UKMED) data relating to trainees who applied for GPHST on the
 national ORIEL application system over a three-quarter decade period
 (2013-2020) and who had lived in England when they applied to medical
 school (earliest date 2007)
 
 with trainee-level longitudinal data relating to their socioeconomic,
 demographic, geographical and academic metrics from pre-undergraduate
 through to postgraduate education (from classroom to clinic).
 
 
 Study one, which explored access to GPHST, found increased diversity in
 applications during the study period. Sole application to GPHST was more
 likely among white trainees, standard entry medicine (SEM) trainees,
 female trainees and trainees with a disability comparative to their
 counterparts. Trainees who
 
 lived pre-medical school in the most deprived quintiles for IMD, LE,
 Indoor LE, Outdoor LE, Income, Employment and Crime deprivation were more
 likely to apply to GPHST in combination with other specialities
 comparative to trainees who lived pre-medical school in the least deprived
 quintiles and all
 
 other quintiles. Direct application to GPHST was less likely among white
 trainees and those from most deprived quintiles for IMD, LE, indoor LE,
 Outdoor LE, Income, Employment, Health and Disability, Crime and Education
 comparative to the least deprived quintiles but not comparative to all
 other quintiles.
 
 Trainees were more likely to be given an offer for a GPHST National
 Training Number if they were female and applied for SEM although there was
 no statistically significant difference in offers of a GPHST national
 training number by level 1 ethnicity. Decision tree analyses provide a
 nuanced understanding of
 
 intersectional factors influencing access.
 
 
 Study two, which explored experience during GPHST, found that observed
 variations in AKT and CSA performance through each of the equalities
 lenses were not inequitable (AKTGini and CSAGini &lt;0.15).
 Multivariate analyses demonstrated that when modelling is adjusted for
 level 1 and level 2 ethnicity,
 
 ethnicity is no longer a predictor of performance but rather socioeconomic
 factors emerge as predictors of performance in the AKT and CSA. The
 magnitude of the attainment gap increases during UG and PG training among
 trainees who lived pre-medical school in the most deprived quintiles for
 IMD, Income
 
 Deprivation, Employment Deprivation, trainees who were on Income Support
 and free school meals. The magnitude of the attainment gap also increases
 during UG training among ethnic minorities, trainees who lived pre-medical
 school in the most deprived quintile for adult skills deprivation (v all
 other quintiles) and those with a religious belief although there were no
 changes in the attainment gap for these characteristics during PG
 training. The magnitude of CYP deprivation gap narrows during UG training
 but widens during PG training.
 
 
 Study three, which investigated outcomes from GPHST, found that
 non-standard ARCP Outcomes were more likely among trainees who were male,
 black/mixed and those who lived pre-medical school in the most deprived
 quintile for Income deprivation v the least deprived quintile or all other
 quintiles. Trainees were less likely to complete CCT timely if they were:
 female, white, disabled or Christian. Trainees who were more likely to
 complete CCT timely included Asian and Indian trainees as well as those
 who lived pre-medical school in the most deprived quintiles for Income,
 Employment, Education, CYP and Adult Skills deprivation in comparison to
 the least deprived quintiles or all other quintiles.
 
 
 This thesis offers significant insights into the extent of equity in the
 GP training pathway from end to end in cohorts over a three-quarter decade
 period. This thesis contributes significant knowledge to the literature
 and to practice across access, experience and outcomes from GPHST with
 implications for
 
 informing policy and driving efforts towards a more equitable GP workforce
 that represents the diverse population it serves. Of particular
 significance, the introduction of Gini coefficients as a measure of the
 degree to which there is equity in educational attainment among diverse
 groups provides a novel
 
 contribution to the field, offering a reproducible methodology across
 medical education.