The award gap affecting international medical graduates in general practice training: results of a scoping review.

BACKGROUND: General practice in the UK is under significant pressure, resulting in a drive to increase training capacity. These additional training posts have historically been filled by international medical graduates (IMGs) who accounted for 50% of UK GP residents in 2025. There is however a significant 'award gap' (previously differential attainment) affecting IMGs in postgraduate GP training. AIM: To identify literature addressing the factors underlying the award gap. DESIGN & SETTING: The scoping review followed the process outlined in the Joanna Briggs Institute (JBI) guidance. Studies eligible for inclusion were those reporting educational outcomes (concept) for IMGs (participants) undertaking UK GP training (context). METHOD: Searches were conducted in Medline, EMBASE, SCOPUS and PsycINFO. A two-step screening process was employed to identify eligible articles. Analysis involved descriptive statistics (number and type of evidence sources) and a basic categorical qualitative analysis. RESULTS: 34 pieces of evidence were identified for inclusion; 24 of these reported findings from a variety of empirical research. Most articles focused on postgraduate examinations as the educational outcome of interest. Broad themes were individual vs systemic factors as predictors of success and the 'deficit model'. CONCLUSION: Previous research has focused on individual factors which predict failure, or on defending the validity of examinations. This has 'responsibilised' IMGs by failing to acknowledge that the responsibility for addressing the award gap lies not just with the individual, but also with the educational system. Further research should consider exploring why the award gap exists so we can tackle the underlying cause.