Tation through specialties impeded effective instruction in all participants; they had been unable to access a array of hospital departments to get clinical experience inparticular curriculum locations (eg, obstetrics and gynaecology, paediatrics). `I’m not going to be undertaking a rotation through that. So whatever I am going to get out of it will be private study and gynaecological individuals that come in to the practice that I see and discussion with my trainers’ [Male, IMG]. Gender barriers Gender was a barrier to efficiency in distinct AKT inquiries for all participants. Male IMG participants had been much less most likely to have attended female patients throughout instruction. `I consider female medical doctors in practice are inclined to see more gynae associated problems. It really is much less awkward to become examined by a female than by a male. I’ve also heard about threat of complaint against the male medical Respiration Inhibitors medchemexpress doctor to sensitive females.’ [Male, IMG]. `I’ve surely observed a few ladies within the final couple of weeks with 1-?Furfurylpyrrole References vaginal discharge.’ [Female, BME UKG]. `I don’t seriously deal with prostate issues substantially becoming a lady medical doctor.’ [Female, UKG]. Uncommon presentations All participants reported issues answering AKT queries from topics that had been uncommon clinicalPattinson J, et al. BMJ Open 2019;9:e030341. doi:ten.1136bmjopen2019Open access presentations generally practice, especially in minor specialties. `Neurology, I am not certain in regard to AKT, which can be a paper exam. Much more like facing an actual patient. Neurology is a difficult specialiity.’ [Female, IMG]. Statistical studying All participants expressed that there had been restricted opportunities for learning statistical aspects on the curriculum but information interpretation and statistics were areas exactly where IMG doctors felt they needed further training help because of limited possibilities to learn statistics at undergraduate level. `As an undergraduate I in no way went by means of statistics. No!’ [Male, IMG]. Because of this IMG participants discovered information interpretation queries complicated compared with UKGs. `We are usually not exposed to things like this (in beneath graduate coaching). Statistics is just not new to us but not within this context. It’s not inside the context of writing it out and clarify. Putting within a graphic or table kind. Not some thing we are applied to. Nothing like this. I do not know (if I desire to have a go at it)’. [Male, IMG]. IMG candidates worried about examination timing which also dissuaded them from answering complex data interpretation or statistical questions. `I’ve completed statistics before, not items they applied in medicine and clinical trials, sensitivity and specificity. That was new to me.'[Female, UKG]. `I’m just thinking I’ve under no circumstances come across such a query (statistics). Or such a table ought to I say. I have not noticed this particular table prior to.’ [Female, BME UKG]. Relevance to common practice All participants struggled with concerns relevant for minor specialty places, administration, or exactly where a referral would be made for secondary and tertiary care remedies. The queries have been felt to become irrelevant towards the function of a GP and were expected to become carried out by other wellness specialists (eg, nurse, midwife or pharmacist) or specialists. `Tend to refer most of them to opticians. Who will then refer to ophthalmologists as required’ [Male, IMG]. `I think it’s more a nurse’s role. The midwife.’ [Male, IMG]. Statistical relevance This was specifically the case for statistics exactly where participants felt questions had been significantly less relevant to each day practice. `Most from the time (sta.