Understanding how disability and ethnicity impact UK undergraduate and postgraduate medical training: A critical review

INTRODUCTION: In recent years, the challenges associated with having a disability and being from a minority ethnic background have emerged from the literature in terms of medical training, career choice and progression, but how these characteristics intersect is less known. Understanding this intersection may improve support mechanisms, promote diversity and enhance workforce retention. This critical review aimed to evaluate all published empirical evidence regarding the impact of disability and ethnicity on the training of UK medical students and qualified doctors, with a specific focus on their intersection. METHODS: The Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines were followed. A range of medical-, nursing- and psychology-based bibliographic databases were used with no date restrictions. Quality appraisal was undertaken for all studies using the Mixed Methods Appraisal Tool (MMAT). A textual narrative method was used to synthesise the data. RESULTS: After an initial 2662 identified articles from the electronic and manual searches, only 25 articles presented data on both disability and ethnicity in undergraduate, graduate-entry and postgraduate medical education contexts. Only a small number specifically addressed intersectionality, with the majority evaluating disability and ethnicity independently. Three key themes emerged related to the diversity of medical students and doctors in UK medical training; factors affecting the educational performance and progression of medical students and qualified doctors in the UK; and adverse treatment in the clinical environment. CONCLUSION: This review has shown how disability and ethnicity can negatively impact medical training, especially with respect to examination performance, levels of support and learning/work-based experience; this effect is more pronounced when both characteristics work interdependently. The results highlight important areas that medical educators need to address, such as support mechanisms and different cultural understandings. Most available data are quantitative and lack critical detail, for example, types of disability and ethnic groups, to fully unpack reasons for educational and training disparities. Further work is therefore recommended, especially with a qualitative focus.