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Why are ethnic minority doctors less successful in academic tests and securing the top jobs than white doctors, ask experts in The BMJ today?

Data show that doctors and medical students from black and ethnic backgrounds are up to three times more likely to fail an exam than .

Ethnic minority doctors are also less likely than white doctors to be shortlisted for, and appointed to, consultant posts, more likely to be bullied and harrassed, and earn 4.9% less than their white consultant counterparts.

This phenomenon is called "differential attainment"—it appears at and persists after qualification. So what is being done about it?

Junior doctor and writer Samara Linton finds that the reasons are complex and include examination bias, a lack of ethnic minority teaching staff, and prejudice within medical curriculums.

But while it's important to ensure that examinations are unbiased and curriculums are inclusive, the evidence points to improving the for ethnic minority students as a target for action.

For example, an international review found that minority medical students "experienced less supportive social and less positive learning environments [and] were subject to discrimination and racial harassment."

Tackling this institutional problem requires openness and strong leadership, says Katherine Woolf, Associate Professor in at University College London medical school, in a linked editorial.

"As teachers we should reflect on who we give additional support and opportunities to, ensure ethnic minority learners stretch themselves, and create opportunities for those from different ethnic groups to learn together since this combats prejudice," she writes. "Fair hiring and promotion processes may also help improve the under-representation of clinical academics, teachers, and supervisors from ethnic minority groups."

"While we don't yet have strong evidence supporting to reduce differential attainment, campaigns on recognising and dealing with discrimination and micro-aggressions are increasing," she adds.

The British Medical Association (BMA) has just launched a charter for on tackling harassment, and BMA council chair, Chaand Nagpaul, sees tackling differential attainment as part of the larger work to create a more inclusive NHS.

"If you want the most productive health service, you want everyone working within it to be their best," he explains. "The current system is inhibiting the ability of each doctor to be their best and flourish."

More information: Taking the difference out of attainment, DOI: 10.1136/bmj.m438 , www.bmj.com/content/368/bmj.m438

Editorial: Differential attainment in medical education and training, www.bmj.com/content/368/bmj.m339