Differential attainment within medical education: a systematic review
Bibliographic record
Abstract
BACKGROUND: Differential attainment describes the systemic differences in outcomes when grouping cohorts by protected characterises and socioeconomic backgrounds. To date, most research studies have focused on a small number of characteristics and outcomes. This systematic review aimed to explore the association between a range of student/trainee characteristics and differential attainment in undergraduate and postgraduate medical education. METHODS: A systematic review was conducted and reported using the Preferred Reporting Items for Systematic Reviews and Meta Analyses (PRISMA) guidelines with searches conducted in May 2023. Outcome measures were assessment, progression through training, and qualification in medical students or trainee doctors. Specific characteristics included were age, disability, entry route to medicine, ethnicity, gender, religion and socio-economic status. The Cochrane RoB tool, the Newcastle-Ottawa Scale and the GRADE approach were applied. A narrative synthesis was conducted due to heterogeneity between studies. RESULTS: Ninety-five studies were included. The majority were observational. There were over 381,815 medical student and 395,191 trainee doctor participants across all studies. The certainty across included studies was low and results were heterogeneous. Most results focused on assessment, followed by progression, then qualification. Gender, ethnicity and age were most commonly studied. Mixed results were noted for gender with results suggesting an advantage for undergraduate females however, females took longer to complete postgraduate training, and males were more likely to be on a specialist register. Minoritised ethnicity was consistently associated with lower attainment across a large number of studies. Younger doctors consistently did better in postgraduate assessments. Only 32 studies examined other characteristics with mixed results for disability and entry routes to medicine. The impact of socioeconomic status varied, but lower status was associated with lower attainment at later career stages. CONCLUSION: Differential attainment is a complex, context-dependent phenomenon with multiple contributory factors that are challenging to disentangle. Despite low certainty of evidence, this review suggests that many characteristics do impact on outcomes in medical education. This warrants further investigation and indicates a need for monitoring and targeted differential attainment interventions to ensure equitable outcomes for medical students and doctors in training. REGISTRATION: This systematic review is registered on PROSPERO, accessible at https://www.crd.york.ac.uk/prospero/display_record.php?ID=CRD42023426933 . PROSPERO has been updated to reflect the progression of this review.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.012 | 0.060 |
| Meta-epidemiology (narrow) | 0.002 | 0.001 |
| Meta-epidemiology (broad) | 0.010 | 0.010 |
| Bibliometrics | 0.011 | 0.013 |
| Science and technology studies | 0.001 | 0.001 |
| Scholarly communication | 0.003 | 0.003 |
| Open science | 0.002 | 0.002 |
| Research integrity | 0.002 | 0.002 |
| Insufficient payload (model declined to judge) | 0.005 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".