Differential attainment in assessment of postgraduate surgical trainees: a scoping review

Abstract

Introduction: Solving disparities in assessments is crucial to a successful surgical training programme. The first step in levelling these inequalities is recognising in what contexts they occur, and what protected characteristics are potentially implicated.

Methods: This scoping review was based on Arksey & O'Malley's guiding principles. OVID and Embase were used to identify articles, which were then screened by three reviewers.

Results: From an initial 358 articles, 53 reported on the presence of differential attainment in postgraduate surgical assessments. The majority were quantitative studies (77.4%), using retrospective designs. 11.3% were qualitative. Differential attainment affects a varied range of protected characteristics. The characteristics most likely to be investigated were gender (85%), ethnicity (37%) and socioeconomic background (7.5%). Evidence of inequalities are present in many types of assessment, including: academic achievements, assessments of progression in training, workplace-based assessments, logs of surgical experience and tests of technical skills.

Conclusion: Attainment gaps have been demonstrated in many types of assessment, including supposedly "objective" written assessments and at revalidation. Further research is necessary to delineate the most effective methods to eliminate bias in higher surgical training. Surgical curriculum providers should be informed by the available literature on inequalities in surgical training, as well as other neighbouring specialties such as medicine or general practice, when designing assessments and considering how to mitigate for potential causes of differential attainment.

Keywords: Assessment; Differential attainment; Disparity; Diversity; Equity; Inequality; Postgraduate.

Fig. 1

PRISMA flow diagram

Fig. 2

Growth in published literature on differential attainment over the past 40 years