A framework for international Medical Graduate success in the applied Knowledge test: approach, awareness, assistance...

Differential attainment (DA) is the disparity between attainment levels of different groups of doctors. The causes are multi-factorial, and variations have been highlighted between International Medical Graduate (IMG) General Practice Registrars (GPRs) and United Kingdom Medical Graduates (UKMGs) in their performance of the UK licensing examination for general practice, the Applied Knowledge Test (AKT). Despite existing support measures, there remains a gap in understanding the effectiveness of interventions aimed at improving examination success for IMGs in the AKT.

To explore the preparation and support methods that IMG GPRs consider contributed to their AKT examination success.

A qualitative study using focus groups and Green et al.'s (2007) model of Thematic Analysis was used to generate codes, categories and themes. The verification techniques of member checking and inter-rater reliability were implemented.

Four focus groups with a total of 13 IMG GPRs were undertaken. Four primary themes emerged from the thematic analysis: 'Awareness of Preparation Required', 'Assistance that Aids AKT Examination Success','Application of Knowledge Gained and Individual Preferences' and 'Approach and Individual Influences'.

This study highlights the perceived importance of personal motivation, early awareness, and proactive support from peers and educators for IMG GPRs to succeed in the AKT. The model of the '4As' (Approach, Awareness, Assistance, and Application) was developed to aid IMG GPRs in achieving success. Local strategic examination support, such as the KSS Curriculum and AKT Support for Training (CAST) programme can facilitate the application of this model. Recommendations include early discussions on differential attainment, the development of a comprehensive AKT program, and tailored educational interventions. The study also recommends further research across diverse training regions to refine educational strategies and ensure equitable opportunities.