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Understanding differential attainment across medical training pathways: A rapid review of the literature

Published: November 2015

What were the key findings?

  • The literature explored differing levels of achievement in medical training – sometimes referred to as differential attainment - in relation to three categories or levels:
    o the ‘macro’ or policy level
    o the ‘meso’ or institutional level and
    o the ‘micro’ or individual/discrete group level;
  • At the macro level, the main studies have been quantitative and have focused on high stakes exams. Broadly these have found no evidence of bias in the nature and structure of exams themselves to explain differential attainment;
  • Postgraduate selection was identified as an under researched area at the miso level, whilst induction and mentoring were identified as promising ways of supporting those who might otherwise have difficulties progressing;
  • A wide range of potential explanatory factors have begun to be explored at the micro level, including learning styles, cultural background and language – but there’s no consensus yet as to their relative importance;
  • Though there isn’t agreement as to the causes of differential attainment, the literature suggests the explanation is likely to involve multiple factors and any attempt to mitigate or address differential attainment will have to take account of factors operating at the macro, miso and micro levels;
  • Different types of support are in place across the UK for trainees. However, there’s little evidence about how effective this support is within the literature;
  • There is a lack of consistency and granularity in the use of key categories in the literature, such as ethnicity and place where a doctor obtained their Primary Medical Qualification. Addressing this, and further using qualitative methods to explore explanatory factors, would help us understand more about differential attainment.

Why did we commission this research?

As part of a broader programme of work to better understand the nature of differential attainment and the actions we might be able to take to help mitigate this, we wanted to understand what the existing literature could tell us regarding causes, effective interventions and promising ways of researching the issue.

What did the research involve?

Researchers carried out a rapid review of 39 academic papers and 24 other documents published between 2004-2015 using a ‘narrative synthesis’ approach.

Full report and further analysis

Full Report (pdf)