Differential attainment within medical education: a systematic review

Area of Science:

• Medical Education Research
• Health Equity Studies
• Systemic Bias Analysis

Background:

• Differential attainment refers to systemic outcome disparities across demographic groups in medical education.
• Existing research often examines limited characteristics and outcomes.
• This review explores associations between diverse student/trainee characteristics and differential attainment.

Purpose of the Study:

• To systematically review the literature on differential attainment in undergraduate and postgraduate medical education.
• To identify associations between various student/trainee characteristics and educational outcomes.
• To inform interventions for equitable medical training.

Main Methods:

• Systematic review following PRISMA guidelines, with searches in May 2023.
• Included studies assessed medical students and trainee doctors, examining outcomes like assessment, progression, and qualification.
• Analyzed characteristics including age, disability, entry route, ethnicity, gender, religion, and socioeconomic status.

Main Results:

• Ninety-five observational studies involving over 770,000 participants were included, with low certainty and heterogeneous evidence.
• Minority ethnicity consistently correlated with lower attainment; younger doctors performed better in postgraduate assessments.
• Gender showed mixed results, while lower socioeconomic status was linked to poorer outcomes later in training.

Conclusions:

• Differential attainment is complex and context-dependent, influenced by multiple factors.
• Despite low evidence certainty, various characteristics significantly impact medical education outcomes.
• Further investigation and targeted interventions are crucial for ensuring equitable outcomes in medical training.