A Scoping Review of Differential Attainment in Undergraduate Medicine Bridging the Gap - Thematic series on Tackling Differential Attainment in Medical Profession 2020

Main Article Content

Subodh Dave
Abhishek Gupta
Natasha Rishi
Radhika Gulati
Shreya Verma
Rohit Shankar MBE
Nagina Khan
Indranil Chakravorty

Abstract

Differential attainment exists in all professions and is a manifestation of systemic factors creating an unequal environment where individual careers and aspirations may be thwarted. Although this inequality which affects some groups of students unfairly, has been recognised over the last 2 decades, it remains a significant issue.


This scoping review explores the causes and contributors in relation to undergraduate medical education. Using thematic analysis, the authors present the case for tackling the disparity in education and training. There are evidence-based solutions for individuals, organisations and at a societal level. The recommendations from this review will be discussed and debated in the series of workshops, as part of the ‘Bridging the Gap’ series from the Alliance for Tackling Inequalities in Health, chaired by the British Association of Physicians of Indian origin. The output of the consensus-building workshops and thematic synthesis with the accompanying qualitative research will be presented in the final report due in 2021.

Article Details

How to Cite
Dave, S., Gupta, A., Rishi, N., Gulati, R., Verma, S., Shankar, R., Khan, N., & Chakravorty, I. (2020). A Scoping Review of Differential Attainment in Undergraduate Medicine: Bridging the Gap - Thematic series on Tackling Differential Attainment in Medical Profession 2020. Sushruta Journal of Health Policy & Opinion, 13(3), 1-10. https://doi.org/10.38192/13.3.24
Section
Policy
Author Biographies

Subodh Dave, University of Bolton, UK

Professor of Psychiatry

Abhishek Gupta, University of Birmingham, UK

Medical Student

Radhika Gulati, Queen's University, Belfast, N Ireland

Student

Shreya Verma, University of Birmingham, UK

Medical Student

Rohit Shankar MBE, University of Exeter Medical School, Exeter, UK

Consultant Adult Developmental Neuropsychiatrist -CFT Associate Professor (Hon.) UoE Medical School Chair- RCPsych SW

Indranil Chakravorty, St George's University of London, UK

Chair, Bapio Institute for Health Research, Bedford, UK

References

1. Protocol for Thematic Synthesis of Differential Attainment in the Medical Profession - ‘Bridging the Gap’ Series | Sushruta Journal of Health Policy & Opinion. Accessed October 31, 2020. https://www.sushrutajnl.net/index.php/sushruta/article/view/91
2. Dave S, Chakravorty I, Menon G, Sidhu K, Bamrah JS, Mehta R. Differential Attainment in Summative Assessments within Postgraduate Medical Education & Training: Sushruta J Health Policy Opin. 2020;13(3). doi:10.38192/13.3.15
3. Executive summary | Falling short: the NHS workforce challenge. Health Foundation. Accessed October 31, 2020. https://reader.health.org.uk/falling-short/executive-summary
4. Capers Q, Clinchot D, McDougle L, Greenwald AG. Implicit Racial Bias in Medical School Admissions. Acad Med J Assoc Am Med Coll. 2017;92(3):365-369. doi:10.1097/ACM.0000000000001388
5. Osseo-Asare A, Balasuriya L, Huot SJ, et al. Minority Resident Physicians’ Views on the Role of Race/Ethnicity in Their Training Experiences in the Workplace. JAMA Netw Open. 2018;1(5):e182723. doi:10.1001/jamanetworkopen.2018.2723
6. The NHS Constitution for England. GOV.UK. Accessed August 31, 2020. https://www.gov.uk/government/publications/the-nhs-constitution-for-england/the-nhs-constitution-for-england
7. Cognitive and Human Factors in Expert Decision Making: Six Fallacies and the Eight Sources of Bias | Analytical Chemistry. Accessed October 31, 2020. https://pubs.acs.org/doi/10.1021/acs.analchem.0c00704
8. Lempp H, Seale C. Medical students’ perceptions in relation to ethnicity and gender: a qualitative study. BMC Med Educ. 2006;6:17. doi:10.1186/1472-6920-6-17
9. Woolf K. Fair Training Pathways for All: Understanding Experiences of Progression - Final Report. :69.
10. msc-selection-alliance-2017-report.pdf. Accessed October 31, 2020. https://www.medschools.ac.uk/media/2388/msc-selection-alliance-2017-report.pdf
11. Mountford-Zimdars A, Sanders J, Moore J, Sabri D, Jones S, Higham L. What can universities do to support all their students to progress successfully throughout their time at university? Perspect Policy Pract High Educ. 2017;21(2-3):101-110. doi:10.1080/13603108.2016.1203368
12. Woolf K, Rich A, Viney R, Needleman S, Griffin A. Perceived causes of differential attainment in UK postgraduate medical training: a national qualitative study. BMJ Open. 2016;6(11):e013429. doi:10.1136/bmjopen-2016-013429
13. Marcelin JR, Siraj DS, Victor R, Kotadia S, Maldonado YA. The Impact of Unconscious Bias in Healthcare: How to Recognize and Mitigate It. J Infect Dis. 2019;220(Supplement_2):S62-S73. doi:10.1093/infdis/jiz214
14. Clack GB, Head JO. Gender differences in medical graduates’ assessment of their personal attributes. Med Educ. 1999;33(2):101-105. doi:10.1046/j.1365-2923.1999.00268.x
15. Alers M, van Leerdam L, Dielissen P, Lagro-Janssen A. Gendered specialities during medical education: a literature review. Perspect Med Educ. 2014;3(3):163-178. doi:10.1007/s40037-014-0132-1
16. Riska E. Gender and medical careers. Maturitas. 2011;68(3):264-267. doi:10.1016/j.maturitas.2010.09.010
17. Meeks LM, Herzer KR. Prevalence of Self-disclosed Disability Among Medical Students in US Allopathic Medical Schools. JAMA. 2016;316(21):2271-2272. doi:10.1001/jama.2016.10544
18. Valdiserri RO, Holtgrave DR, Poteat TC, Beyrer C. Unraveling Health Disparities Among Sexual and Gender Minorities: A Commentary on the Persistent Impact of Stigma. J Homosex. 2019;66(5):571-589. doi:10.1080/00918369.2017.1422944
19. Toman L. Navigating medical culture and LGBTQ identity. Clin Teach. 2019;16(4):335-338. doi:10.1111/tct.13078
20. Sánchez NF, Rankin S, Callahan E, et al. LGBT Trainee and Health Professional Perspectives on Academic Careers--Facilitators and Challenges. LGBT Health. 2015;2(4):346-356. doi:10.1089/lgbt.2015.0024
21. Dimant OE, Cook TE, Greene RE, Radix AE. Experiences of Transgender and Gender Nonbinary Medical Students and Physicians. Transgender Health. 2019;4(1):209-216. doi:10.1089/trgh.2019.0021
22. Levine RB, Mechaber HF, Reddy ST, Cayea D, Harrison RA. “A good career choice for women”: female medical students’ mentoring experiences: a multi-institutional qualitative study. Acad Med J Assoc Am Med Coll. 2013;88(4):527-534. doi:10.1097/ACM.0b013e31828578bb
23. Kalén S, Ponzer S, Silén C. The core of mentorship: medical students’ experiences of one-to-one mentoring in a clinical environment. Adv Health Sci Educ Theory Pract. 2012;17(3):389-401. doi:10.1007/s10459-011-9317-0
24. Kow CS, Teo YH, Teo YN, et al. A systematic scoping review of ethical issues in mentoring in medical schools. BMC Med Educ. 2020;20(1):246. doi:10.1186/s12909-020-02169-3
25. Glock S, Schuchart C. The ethnic match between students and teachers: evidence from a vignette study. Soc Psychol Educ. 2020;23(1):27-50. doi:10.1007/s11218-019-09525-2
26. Scanlan GM, Cleland J, Stirling SA, Walker K, Johnston P. Does initial postgraduate career intention and social demographics predict perceived career behaviour? A national cross-sectional survey of UK postgraduate doctors. BMJ Open. 2019;9(8):e026444. doi:10.1136/bmjopen-2018-026444
27. Meeks LM, Herzer K, Jain NR. Removing Barriers and Facilitating Access: Increasing the Number of Physicians With Disabilities. Acad Med J Assoc Am Med Coll. 2018;93(4):540-543. doi:10.1097/ACM.0000000000002112
28. Wheeler M, de Bourmont S, Paul-Emile K, et al. Physician and Trainee Experiences With Patient Bias. JAMA Intern Med. 2019;179(12):1678. doi:10.1001/jamainternmed.2019.4122
29. Woolf K, Viney R, Rich A, Jayaweera H, Griffin A. Organisational perspectives on addressing differential attainment in postgraduate medical education: a qualitative study in the UK. BMJ Open. 2018;8(3). doi:10.1136/bmjopen-2017-021314
30. Isik U, Wouters A, Ter Wee MM, Croiset G, Kusurkar RA. Motivation and academic performance of medical students from ethnic minorities and majority: a comparative study. BMC Med Educ. 2017;17(1):233. doi:10.1186/s12909-017-1079-9
31. Nunn S. Understanding differential attainment across medical training pathways: A rapid review of the literature. :89.
32. Claridge H, Stone K, Ussher M. The ethnicity attainment gap among medical and biomedical science students: a qualitative study. BMC Med Educ. 2018;18(1):325. doi:10.1186/s12909-018-1426-5
33. Low D, Pollack SW, Liao ZC, et al. Racial/Ethnic Disparities in Clinical Grading in Medical School. Teach Learn Med. 2019;31(5):487-496. doi:10.1080/10401334.2019.1597724
34. Woolf K, McManus IC, Potts HWW, Dacre J. The mediators of minority ethnic underperformance in final medical school examinations: The mediators of minority ethnic underperformance in final medical school examinations. Br J Educ Psychol. 2013;83(1):135-159. doi:10.1111/j.2044-8279.2011.02060.x
35. Stegers-Jager KM, Steyerberg EW, Cohen-Schotanus J, Themmen APN. Ethnic disparities in undergraduate pre-clinical and clinical performance. Med Educ. 2012;46(6):575-585. doi:10.1111/j.1365-2923.2012.04265.x
36. Stegers-Jager KM, Brommet FN, Themmen APN. Ethnic and social disparities in different types of examinations in undergraduate pre-clinical training. Adv Health Sci Educ Theory Pract. 2016;21(5):1023-1046. doi:10.1007/s10459-016-9676-7
37. Stegers-Jager KM. Is it them or is it us? Unravelling ethnic disparities in undergraduate clinical performance. BMC Med. 2017;15(1):190. doi:10.1186/s12916-017-0959-5
38. van Andel CEE, Born MP, Themmen APN, Stegers-Jager KM. Broadly sampled assessment reduces ethnicity-related differences in clinical grades. Med Educ. 2019;53(3):264-275. doi:10.1111/medu.13790
39. Kelly S, Dennick R. Evidence of gender bias in True-False-Abstain medical examinations. BMC Med Educ. 2009;9:32. doi:10.1186/1472-6920-9-32
40. Cecilio-Fernandes D, Bremers A, Collares CF, Nieuwland W, Vleuten C van der, Tio RA. Investigating possible causes of bias in a progress test translation: an one-edged sword. Korean J Med Educ. 2019;31(3):193-204. doi:10.3946/kjme.2019.130
41. Vaughan S, Sanders T, Crossley N, O’Neill P, Wass V. Bridging the gap: the roles of social capital and ethnicity in medical student achievement. Med Educ. 2015;49(1):114-123. doi:10.1111/medu.12597
42. Schoonheim-Klein M, Hoogstraten J, Habets L, et al. Language background and OSCE performance: a study of potential bias. Eur J Dent Educ Off J Assoc Dent Educ Eur. 2007;11(4):222-229. doi:10.1111/j.1600-0579.2007.00459.x
43. Rojek AE, Khanna R, Yim JWL, et al. Differences in Narrative Language in Evaluations of Medical Students by Gender and Under-represented Minority Status. J Gen Intern Med. 2019;34(5):684-691. doi:10.1007/s11606-019-04889-9
44. Weinand JD, Ehlinger EP, Conniff JF, Hayon RL, Kvach E. Supporting Transgender and Nonbinary Residents. Transgender Health. 2019;4(1):222-225. doi:10.1089/trgh.2018.0074
45. Rosser SV, Barnard S, Carnes M, Munir F. Athena SWAN and ADVANCE: effectiveness and lessons learned. Lancet Lond Engl. 2019;393(10171):604-608. doi:10.1016/S0140-6736(18)33213-6
46. Garlick PB, Brown G. Widening participation in medicine. BMJ. 2008;336(7653):1111-1113. doi:10.1136/bmj.39508.606157.BE
47. Medical school widening participation work boosted by powerful data tool | Medical Schools Council. Accessed October 31, 2020. https://www.medschools.ac.uk/news/medical-school-widening-participation-work-boosted-by-powerful-data-tool
48. NHS England » NHS Workforce Race Equality Standard. Accessed May 24, 2020. https://www.england.nhs.uk/about/equality/equality-hub/equality-standard/
49. Black Lives Matter. In: Wikipedia. ; 2020. Accessed August 6, 2020. https://en.wikipedia.org/w/index.php?title=Black_Lives_Matter&oldid=971334380
50. Roberts LW. Belonging, Respectful Inclusion, and Diversity in Medical Education. Acad Med. 2020;95(5):661–664. doi:10.1097/ACM.0000000000003215

Most read articles by the same author(s)