Exploring the mechanisms driving the award gap between international and UK medical graduates in general practice training: a realist review protocol

Journal article

BACKGROUND: International medical graduates (IMGs) currently account for 41% of the UK medical workforce. IMGs in training posts face challenges in progression including a significant 'award gap' (previously differential attainment) in postgraduate training compared to UK medical graduates. General practice (GP) is disproportionately impacted by these issues in progression as over 50% of GP trainees are IMGs. AIM: To explore the phenomenon of the 'award gap' existing between international medical graduates (IMGs) and UK medical graduates in general practice training. DESIGN & SETTING: The realist review will be reported according to the RAMESES quality standards for realist synthesis. Included papers will report on UK GP training outcomes for IMGs. METHOD: Searches will build on those from an earlier scoping review whose results were also used to develop an initial programme theory (IPT). Those data which support the further development of the IPT will be extracted and coded. Codes will be prioritised according to the insight they provide into the mechanisms (M) and contexts (C) which impact outcomes (O) for IMG GP residents and their patients. Context mechanism outcome configurations (CMOCs) will be built from the codes and mapped against the IPT. CONCLUSION: This realist review will advance knowledge by examining the mechanisms and contextual factors at play in general practice training, providing explanations for educational outcomes for IMGs themselves and impacts on patient populations they serve. This will enable the development of interventions and policy to support the GP IMG resident workforce.

Authors: Emery, LJ; Faseyosan, V; Hoverd, E; Roberts, NW; Wong, G

• Publication status: Published
• Peer review status: Peer reviewed
• Publisher: Royal College of General Practitioners
• Journal: British Journal of General Practice Open More from this journal
• Pages: BJGPO.2026.0185-BJGPO.2026.0185
• Publication date: 2026-10-27
• Acceptance date: 2026-10-22
• DOI: 10.3399/BJGPO.2026.0185
• EISSN: 2398-3795
• ISSN: 2398-3795
• Language: English
• Keywords: context-mechanism-outcome configurations; graduate medical education; program theory; general practice workforce; patient outcomes; differential attainment; general practice training; international medical graduates; exercise progression