Understanding differential attainment across medical training pathways: A rapid review of the literature Final report prepared for The General Medical Council Dr Sam Regan de Bere, Dr Suzanne Nunn, Dr Mona Nasser 21/08/2015 Funded by the General Medical Council. The views expressed in this report are those of the participants and the authors and do not necessarily reflect those of the General Medical Council. 1 1 Contents Table of Figures .......................................................................................................................... 4 Table of Abbreviations and Acronyms ....................................................................................... 4 Executive Summary .................................................................................................................... 5 Introduction ............................................................................................................................... 5 Research design ................................................................................................................. 5 Analysis ............................................................................... Error! Bookmark not defined. Current narratives of differential attainment ................................................................ 10 1. Introduction ..................................................................................................................... 14 2 Background ...................................................................................................................... 15 3 Aims and purposes of the review .................................................................................... 15 4 Methodology .................................................................................................................... 16 4.1 Rapid review .............................................................................................................. 16 4.2 Narrative synthesis .................................................................................................... 16 5 Methods ........................................................................................................................... 17 5.1 Development and registration of protocol ............................................................... 17 5.2 Search strategy .......................................................................................................... 17 5.3 Data management and extraction ............................................................................ 20 5.4 Quality assurance ...................................................................................................... 20 6 Research Ethics ................................................................................................................ 22 7 Data Analysis .................................................................................................................... 22 8 Narrative synthesis .......................................................................................................... 25 9 Findings ............................................................................................................................ 26 9.1 The Individual or discrete group ............................................................................... 26 Study habits ..................................................................................................................... 27 Psycho-social .................................................................................................................... 27 2 Social and cultural capital ................................................................................................ 28 Success ............................................................................................................................. 28 Ethnicity ........................................................................................................................... 29 IMG ................................................................................................................................... 31 Language .......................................................................................................................... 34 Gender ............................................................................................................................. 36 9.2 The institutional ........................................................................................................ 37 The Medical School and the working environment ......................................................... 37 Mentoring ........................................................................................................................ 38 Selection ........................................................................................................................... 38 9.3 Policy ......................................................................................................................... 39 Predictors of success at postgraduate level .................................................................... 39 PMQ ................................................................................................................................. 40 High stakes examinations ................................................................................................ 40 MRCGP and MRCGP Clinical Skills Assessment (CSA) ...................................................... 41 Examiner bias ................................................................................................................... 43 10 Discussion......................................................................................................................... 45 10.1 Causes .................................................................................................................... 45 10.2 Ways of researching .............................................................................................. 46 10.3 Possible interventions ........................................................................................... 48 11 Conclusions (the story so far) .......................................................................................... 50 12 References ....................................................................................................................... 52 13 Appendices ....................................................................................................................... 56 Appendix 1: Studies and other documents included in the synthesis ............................... 56 Appendix 2: Quality evaluation of studies using primary data............................................ 87 3 Table of Figures Figure 1. Flow diagram of study selection ............................................................................... 23 Figure 2 Analysis of included studies and documents by methodology or type ..................... 24 Figure 3. Publication by date ................................................................................................... 25 Figure 4. Conceptual map of themes identified in the published literature ........................... 26 Table of Abbreviations and Acronyms AoMRC Academy of Medical Royal Colleges BME Black and minority ethnic BAPIO British Association of Physicians of Indian Origin CSA Clinical skills assessment FRCA Fellow of the Royal College of Anaesthetists (examination) GMC General Medical Council HEFCE Higher Education Funding Council for England HEFCE Higher Education Funding Council for England IELTS International English Language Testing System IMG International medical graduates MCAT Medical College Admission Test (USA) MRCOG Member of the Royal College of Obstetricians and Gynaecologists (examination) MRCPsych Member of the Royal College of Psychiatrists MCQ Multiple choice question NBME National Board of Medical Examiners (USA) OSCE Objective Structured Clinical Examinations PMQ Primary medical qualification PLAB Professional and Linguistics Assessment Board examination RCA Royal College of Anaesthetists RCGP Royal College of General Practitioners RCOG Royal College of Obstetricians and Gynaecologists USMLE United States Medical Licensing Examination 4 Executive Summary Introduction Differential attainment is a term used to describe the variations in levels of educational achievement that occur between different demographic groups undertaking the same assessment. Differential attainment has been recognised as a challenge for medical professionals and educators since the 1990s, and has been observed in both undergraduate and postgraduate contexts. It is not specific to medical education; it is a feature of professional education more generally. Since 2010 the GMC has worked with others analysing data in order to better understand the progress of trainees through their programmes and to identify any potential differences between demographic groups. This rapid review of literature published in the period between 2004 and the present day contributes to a wider programme of research being carried out by the GMC to explore differential attainment across training pathways. Research design The research was commissioned to provide a rapid review of the corpus of knowledge relating to differential attainment. The researchers adopted a narrative synthesis methodology in order to explore how contributions to the literature