Abstract
IntroductionSystematic and structural inequities in power and privilege create differential attainment whereby differences in average levels of performance are observed between students from different socio-demographic groups. This paper reviews the international evidence on differential attainment related to ethnicity/race in medical school, drawing together the key messages from research to date to provide guidance for educators to operationalize and enact change and identify areas for further research.MethodsAuthors first identified areas of conceptual importance within differential attainment (learning, assessment, and systems/institutional factors) which were then the focus of a targeted review of the literature on differential attainment related to ethnicity/race in medical education and, where available and relevant, literature from higher education more generally. Each author then conducted a review of the literature and proposed guidelines based on their experience and research literature. The guidelines were iteratively reviewed and refined between all authors until we reached consensus on the Do’s, Don’ts and Don’t Knows.ResultsWe present 13 guidelines with a summary of the research evidence for each. Guidelines address assessment practices (assessment design, assessment formats, use of assessments and post-hoc analysis) and educational systems and cultures (student experience, learning environment, faculty diversity and diversity practices).ConclusionsDifferential attainment related to ethnicity/race is a complex, systemic problem reflective of unequal norms and practices within broader society and evident throughout assessment practices, the learning environment and student experiences at medical school. Currently, the strongest empirical evidence is around assessment processes themselves. There is emerging evidence of minoritized students facing discrimination and having different learning experiences in medical school, but more studies are needed. There is a pressing need for research on how to effectively redress systemic issues within our medical schools, particularly related to inequity in teaching and learning.
Highlights
Systematic and structural inequities in power and privilege create differential attainment whereby differences in average levels of performance are observed between students from different sociodemographic groups
While we focused on identifying empirical studies, we drew on perspective pieces to help identify how differential attainment related to ethnicity/race has been conceptualized in the literature
We drew from the research to gain insight into how differential attainment manifests, how it is experienced by medical students and what strategies, or approaches, can be used to redress inequalities
Summary
Systematic and structural inequities in power and privilege create differential attainment whereby differences in average levels of performance are observed between students from different sociodemographic groups. The systematic, or structural, inequity of power and privilege create differential attainment. Differential attainment refers to unexplained variation in average (not individual) levels of performance on educational assessments between students from different societal groups. These students report different experiences of education (see later for further discussion). While student socio-demographic characteristics are statistically correlated with differential outcomes, these should not be interpreted as causal. Interpreting causality based on student demographic characteristics contributes to deficit thinking [2] in which students from lower performing groups are seen as in some way deficient due to their backgrounds, even when acknowledging the social and institutional drivers of minoritization for these identities
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