November marked one year since the Faculty of Public Health (FPH) published the Fair Exams Report, the first comprehensive analysis of differential attainment in its postgraduate examinations.
On analysis of ten years of exam data, the report found that the odds of passing the Diplomate Faculty of Public Health (DFPH) exam on first attempt were lower for older candidates, those from black, Asian, or White Other ethnic backgrounds, and those from multi-professional or non-UK public health training backgrounds. In the Membership of Faculty of Public Health (MFPH) exam, the odds of passing on first attempt were lower for older candidates, and those from black and Asian ethnic backgrounds.
While our exams are designed to be fair, inequalities in exam outcomes persist. The findings of the report sparked a shared commitment across the FPH and with wider stakeholders to understand and address unfair differences in exam outcomes. One year on, we want to share what’s been achieved so far and where we’re heading next.
Embedding Fairness in the Training Pathway
Our postgraduate exams are an important milestone in public health careers, shaping who progresses to consultant level. Candidates also invest a significant amount of time, energy and financial resource into each sitting. So it’s essential that every candidate, no matter their background or training route, has an equitable opportunity to reach their full potential and succeed in the FPH exams.
The work on Fair Exams is now a core part of the Faculty’s wider Fair Training Strategy, which aims to embed fairness, equity, diversity, and inclusion throughout the entire training pathway - from recruitment and examinations to Annual Review of Competence Progression (ARCP) outcomes and post-training career opportunities. We envision a specialist training pathway, training environment and career progression that is equitable, inclusive, and empowering for all, regardless of personal background or training route.
However, we also recognise that there are multiple equivalent routes to specialist registration and a wider public health workforce beyond specialist roles. We are working closely with partner organisations including the UK Public Health Register (UKPHR), and Hong Kong College of Community Medicine (HKCCM) in our Fair Exams programme of work to ensure the needs and experiences of all exam candidates are incorporated into our work plan.
Fair Exams Steering Group
The Fair Exams Steering Group was set up to lead this work, working closely with the Education Committee and Equity, Diversity and Inclusion Committee and Special Interest Group. The group has adopted three key principles in its approach:
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Taking action alongside building the evidence base: We are continuing to research and understand the causes of differential attainment in public health exams, but that process won’t delay meaningful action to close existing gaps.
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Proportionate universalism: Support measures are being designed to benefit all candidates, with additional, targeted assistance for those facing greater barriers to success.
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Sustainability and collaboration: We aim to embed interventions into the everyday work of the FPH and training programmes to ensure lasting cultural and systemic change, rather than relying on short-term projects.
These principles align with the FPH 2025–2030 Strategy, which commits to promoting health equity and tackling differential attainment across the full training pathway.
What’s happened so far?
Since the publication of the Fair Exams Report, a range of actions have been set in motion:
Leadership and Governance:
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The Fair Exams Steering Group is now fully established, overseeing the implementation of recommendations and maintaining momentum across all workstreams.
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The FPH has also been sharing learning and good practice with other Royal Colleges through the Academy of Medical Royal Colleges (AoMRC) and GMC events, contributing to work across specialties to reduce attainment gaps.
Research and insight:
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A qualitative research study, led by Imperial College London, is underway to explore the factors that contribute to differential attainment in the DFPH examination. The study will capture perspectives from candidates of all backgrounds, examiners, and educational supervisors to inform future interventions.
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DFPH application forms are being updated to collect richer demographic data, enabling more accurate and transparent monitoring of attainment gaps over time and addressing some of the data limitations identified in the original report.
Supporting candidates’ preparation and feedback:
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Work is underway to map existing regional exam preparation and feedback opportunities against the AoMRC principles. This will help ensure greater consistency across the country and identify good practice that can be shared widely.
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In collaboration with the DFPH Development Committee, a pilot project will launch in December 2025, offering narrative feedback from a DFPH examiner to UK Public Health Registrars who have resat the exam three or more times as they prepare for their fourth or more attempt. The pilot’s impact, usefulness, and feasibility will be evaluated by the Steering Group.
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Additional DFPH practice questions and mark schemes have also been released, aligned with the current exam format to support candidate preparation.
Curriculum and Assessments:
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A Strategic Assessment Review Group has been established under the governance of the Education Committee to review the methodology of both DFPH and MFPH examinations.
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Representatives from the Fair Exams Steering Group are also feeding into the FPH’s curriculum review process.
We recognise that there is still much to do, but each of these actions represents a small important step towards the goal of fairer, more transparent, and more supportive examination processes and preparation.
What’s Next?
Over the next twelve months, the Fair Exams Steering Group will draw together the findings from the Strategic Assessment Review Group, Imperial College’s qualitative research project, our mapping exercise looking at regional feedback and exam preparation support, and the DFPH feedback pilot. We will be developing additional resources for all exam candidates, including discussion videos with examiners around exam technique, and exploring how we can better support the wellbeing needs of candidates affected by attainment gaps as they prepare for resit attempts.
In addition, looking beyond exams, we have recently launched the Faculty’s Fair Training Strategy. The next phase of this programme will explore how unfair differences may appear throughout the specialty training journey, for example in ARCP outcomes, progression, and post-training opportunities.
How can you get involved?
Tackling differential attainment is a shared responsibility across the public health community. We invite all FPH members to engage with the Fair Exams work - whether by contributing to research, sharing good practice, or championing fair training cultures within your own teams.
Together, we can ensure that every public health professional, whatever their background, has a fair opportunity to succeed and to contribute their talents to improving the health of our communities.
Specific opportunities to get involved include:
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Join the qualitative research study team led by Imperial College to explore differential attainment in the Faculty of Public Health Diplomate examination. You can find out more here.
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Take on a supported national leadership opportunity to lead the implementation of the Faculty’s Fair Training Strategy. You can find out more under “Fair Training Strategy – Deputy Strategic Leads” here.
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If you would be interested in supporting the work of the Fair Exams group in another way, please contact Samia (samia.latif@ukhsa.gov.uk) and Caroline (carolinewren@fph.org.uk)
FPH thanks those members who have supported this work including Samia Latif, Rachel Fardon, Janice Lo, Kevin Smith, Denise Blair, Michael Dalili, Dianne Draper, Fiona Simmons-Jones, Catherine Mbema, Helene Denness, Gill Jones, Pui Hong Chung, John Battersby, Richard Jarvis, Mariam Sbaiti, Jack Haywood, Diane Lloyd and Imose Itua
