Public health professionals that have previously sat the Faculty of Public Health (FPH) postgraduate public health specialty exams will know that passing them is no mean feat! Hours of studying, completing passed papers and facing the potential cost of exam resits are things that many of us are pleased are behind us.

But a recent report from the FPH has shed light on inequalities that exist in examination attainment, which mean that for some sitting the exam, the process is even more arduous.

I myself was one of the candidates that needed to resit much to my disappointment and dismay. To read that I had failed to pass after spending hours in ‘Part A prep mode’ and a significant sum of money to register for the exam, was a real challenge.  Not to mention summoning up the energy to resit, whilst at the same time completing public health training.

So when I came across the FPH differential attainment work in my role as FPH Local Board Member for London, the results quite naturally piqued my interest, having previously been in the position of failing the exam and being in one of the demographic groups that face inequalities in passing.

It is known across medical specialties that exam outcomes differ between groups in ways not explained by ability, but rather systematic inequities in the process of career development and examination itself. As a specialty dedicated to reducing inequalities, it is particularly important that public health understands and acts on ways to reduce differential attainment within its workforce development pathways.

As part of its work on Fair Training Culture the FPH have published a report addressing differential attainment in postgraduate public health examinations.

From analysing ten years of national performance data for initial attempts at the first (DFPH) and second (MFPH) postgraduate public health specialty exams, clear differences were seen in pass rates across demographic groups despite all candidates having demonstrated eligibility to sit the exams and most having already entered highly competitive specialty training.

For the DFPH this included candidates of increasing age, Black, Asian or White Other ethnicity, a professional background other than medicine, and candidates outside of UK public health specialty training, whilst for the MFPH this included candidates of increasing age and Black or Asian ethnicity.

A series of recommendations are laid out in the report which include developing more inclusive educational and working environments in public health and addressing gaps in data collected for those most disadvantaged, including registrars who leave training as a result of repeated exam failure.

The FPH has supported the development of the findings through its Fair Training Culture workstream, and has committed with other stakeholders to address inequalities throughout the training pathway.

Dr Sam Tweed (Co-chair of the FPH Specialty Registrar Committee) and I have reflected on the findings.

“Repeated examination attempts place an enormous financial and emotional toll on those building a career in public health and it is unfair that these fall most heavily on individuals already experiencing additional hurdles to access public health career development and entering specialty training,” said Dr Tweed.

“We have heard from registrars about the further stress and opportunities lost as a result of examination repeats and how this affects their longer-term career too. It is important that the recommendations of this report are addressed, including more understanding of the exam experience of candidates from minoritised groups, with more support and feedback available to those who do not pass on their initial attempt.”

As co-lead of the ADPHL Public Health Tackling Racism and Inequality programme, I am committed to tackling racism as a public health issue, which includes diversifying the workforce and encouraging systems leadership to address inequalities in recruitment and progression through public health as a profession. This is essential for improving the health of Londoners and building trust with the communities we serve.

I will be part of a working group that is aiming to take forward the recommendations from the report, and will be focusing my contributions on getting the perspectives of those who have lived experience of the inequalities outlined in the report.

If you would like to be part of this work or have an experience to share please contact the ADPH London PHTR&I programme at  phtri@cityandhackneyph.hackney.gov.uk. There is some way to go to address these inequalities but this report is an important point in the journey to achieving equity in the public health examination process.