case study methodology in postgraduate research

To read this content please select one of the options below:

Please note you do not have access to teaching notes, processes of a case study methodology for postgraduate research in marketing.

European Journal of Marketing

ISSN : 0309-0566

Article publication date: 1 October 1998

Qualitative research has not been viewed as a rigorous alternative to established quantitative methods in postgraduate marketing research. However, this paper reports on the Australian development of a successful, structured approach to using the case study methodology in postgraduate research. Its aim is to present and justify guidelines for using the case study research methodology in honours, masters and PhD research theses, and so it should interest candidates and their supervisors. First, appropriate positions on a range of scientific paradigms and core issues of induction and deduction are established. Then implementation of the case study methodology is examined, including the numbers of case studies and of interviews. Unusual but effective uses of theoretical replication to rigorously analyze case study data are illustrated from postgraduate theses. Finally, a framework is provided for constructing a thesis, emphasizing the key methodology chapter.

• Case studies
• Marketing research
• Marketing theory
• Methodology

Perry, C. (1998), "Processes of a case study methodology for postgraduate research in marketing", European Journal of Marketing , Vol. 32 No. 9/10, pp. 785-802. https://doi.org/10.1108/03090569810232237

Copyright © 1998, MCB UP Limited

Related articles

We’re listening — tell us what you think, something didn’t work….

Report bugs here

All feedback is valuable

Please share your general feedback

Join us on our journey

Platform update page.

Visit emeraldpublishing.com/platformupdate to discover the latest news and updates

Questions & More Information

Answers to the most commonly asked questions here

• Privacy Policy

Home » Case Study – Methods, Examples and Guide

Case Study – Methods, Examples and Guide

Table of Contents

A case study is a research method that involves an in-depth examination and analysis of a particular phenomenon or case, such as an individual, organization, community, event, or situation.

It is a qualitative research approach that aims to provide a detailed and comprehensive understanding of the case being studied. Case studies typically involve multiple sources of data, including interviews, observations, documents, and artifacts, which are analyzed using various techniques, such as content analysis, thematic analysis, and grounded theory. The findings of a case study are often used to develop theories, inform policy or practice, or generate new research questions.

Types of Case Study

Types and Methods of Case Study are as follows:

Single-Case Study

A single-case study is an in-depth analysis of a single case. This type of case study is useful when the researcher wants to understand a specific phenomenon in detail.

For Example , A researcher might conduct a single-case study on a particular individual to understand their experiences with a particular health condition or a specific organization to explore their management practices. The researcher collects data from multiple sources, such as interviews, observations, and documents, and uses various techniques to analyze the data, such as content analysis or thematic analysis. The findings of a single-case study are often used to generate new research questions, develop theories, or inform policy or practice.

Multiple-Case Study

A multiple-case study involves the analysis of several cases that are similar in nature. This type of case study is useful when the researcher wants to identify similarities and differences between the cases.

For Example, a researcher might conduct a multiple-case study on several companies to explore the factors that contribute to their success or failure. The researcher collects data from each case, compares and contrasts the findings, and uses various techniques to analyze the data, such as comparative analysis or pattern-matching. The findings of a multiple-case study can be used to develop theories, inform policy or practice, or generate new research questions.

Exploratory Case Study

An exploratory case study is used to explore a new or understudied phenomenon. This type of case study is useful when the researcher wants to generate hypotheses or theories about the phenomenon.

For Example, a researcher might conduct an exploratory case study on a new technology to understand its potential impact on society. The researcher collects data from multiple sources, such as interviews, observations, and documents, and uses various techniques to analyze the data, such as grounded theory or content analysis. The findings of an exploratory case study can be used to generate new research questions, develop theories, or inform policy or practice.

Descriptive Case Study

A descriptive case study is used to describe a particular phenomenon in detail. This type of case study is useful when the researcher wants to provide a comprehensive account of the phenomenon.

For Example, a researcher might conduct a descriptive case study on a particular community to understand its social and economic characteristics. The researcher collects data from multiple sources, such as interviews, observations, and documents, and uses various techniques to analyze the data, such as content analysis or thematic analysis. The findings of a descriptive case study can be used to inform policy or practice or generate new research questions.

Instrumental Case Study

An instrumental case study is used to understand a particular phenomenon that is instrumental in achieving a particular goal. This type of case study is useful when the researcher wants to understand the role of the phenomenon in achieving the goal.

For Example, a researcher might conduct an instrumental case study on a particular policy to understand its impact on achieving a particular goal, such as reducing poverty. The researcher collects data from multiple sources, such as interviews, observations, and documents, and uses various techniques to analyze the data, such as content analysis or thematic analysis. The findings of an instrumental case study can be used to inform policy or practice or generate new research questions.

Case Study Data Collection Methods

Here are some common data collection methods for case studies:

Interviews involve asking questions to individuals who have knowledge or experience relevant to the case study. Interviews can be structured (where the same questions are asked to all participants) or unstructured (where the interviewer follows up on the responses with further questions). Interviews can be conducted in person, over the phone, or through video conferencing.

Observations

Observations involve watching and recording the behavior and activities of individuals or groups relevant to the case study. Observations can be participant (where the researcher actively participates in the activities) or non-participant (where the researcher observes from a distance). Observations can be recorded using notes, audio or video recordings, or photographs.

Documents can be used as a source of information for case studies. Documents can include reports, memos, emails, letters, and other written materials related to the case study. Documents can be collected from the case study participants or from public sources.

Surveys involve asking a set of questions to a sample of individuals relevant to the case study. Surveys can be administered in person, over the phone, through mail or email, or online. Surveys can be used to gather information on attitudes, opinions, or behaviors related to the case study.

Artifacts are physical objects relevant to the case study. Artifacts can include tools, equipment, products, or other objects that provide insights into the case study phenomenon.

How to conduct Case Study Research

Conducting a case study research involves several steps that need to be followed to ensure the quality and rigor of the study. Here are the steps to conduct case study research:

• Define the research questions: The first step in conducting a case study research is to define the research questions. The research questions should be specific, measurable, and relevant to the case study phenomenon under investigation.
• Select the case: The next step is to select the case or cases to be studied. The case should be relevant to the research questions and should provide rich and diverse data that can be used to answer the research questions.
• Collect data: Data can be collected using various methods, such as interviews, observations, documents, surveys, and artifacts. The data collection method should be selected based on the research questions and the nature of the case study phenomenon.
• Analyze the data: The data collected from the case study should be analyzed using various techniques, such as content analysis, thematic analysis, or grounded theory. The analysis should be guided by the research questions and should aim to provide insights and conclusions relevant to the research questions.
• Draw conclusions: The conclusions drawn from the case study should be based on the data analysis and should be relevant to the research questions. The conclusions should be supported by evidence and should be clearly stated.
• Validate the findings: The findings of the case study should be validated by reviewing the data and the analysis with participants or other experts in the field. This helps to ensure the validity and reliability of the findings.
• Write the report: The final step is to write the report of the case study research. The report should provide a clear description of the case study phenomenon, the research questions, the data collection methods, the data analysis, the findings, and the conclusions. The report should be written in a clear and concise manner and should follow the guidelines for academic writing.

Examples of Case Study

Here are some examples of case study research:

• The Hawthorne Studies : Conducted between 1924 and 1932, the Hawthorne Studies were a series of case studies conducted by Elton Mayo and his colleagues to examine the impact of work environment on employee productivity. The studies were conducted at the Hawthorne Works plant of the Western Electric Company in Chicago and included interviews, observations, and experiments.
• The Stanford Prison Experiment: Conducted in 1971, the Stanford Prison Experiment was a case study conducted by Philip Zimbardo to examine the psychological effects of power and authority. The study involved simulating a prison environment and assigning participants to the role of guards or prisoners. The study was controversial due to the ethical issues it raised.
• The Challenger Disaster: The Challenger Disaster was a case study conducted to examine the causes of the Space Shuttle Challenger explosion in 1986. The study included interviews, observations, and analysis of data to identify the technical, organizational, and cultural factors that contributed to the disaster.
• The Enron Scandal: The Enron Scandal was a case study conducted to examine the causes of the Enron Corporation’s bankruptcy in 2001. The study included interviews, analysis of financial data, and review of documents to identify the accounting practices, corporate culture, and ethical issues that led to the company’s downfall.
• The Fukushima Nuclear Disaster : The Fukushima Nuclear Disaster was a case study conducted to examine the causes of the nuclear accident that occurred at the Fukushima Daiichi Nuclear Power Plant in Japan in 2011. The study included interviews, analysis of data, and review of documents to identify the technical, organizational, and cultural factors that contributed to the disaster.

Application of Case Study

Case studies have a wide range of applications across various fields and industries. Here are some examples:

Business and Management

Case studies are widely used in business and management to examine real-life situations and develop problem-solving skills. Case studies can help students and professionals to develop a deep understanding of business concepts, theories, and best practices.

Case studies are used in healthcare to examine patient care, treatment options, and outcomes. Case studies can help healthcare professionals to develop critical thinking skills, diagnose complex medical conditions, and develop effective treatment plans.

Case studies are used in education to examine teaching and learning practices. Case studies can help educators to develop effective teaching strategies, evaluate student progress, and identify areas for improvement.

Social Sciences

Case studies are widely used in social sciences to examine human behavior, social phenomena, and cultural practices. Case studies can help researchers to develop theories, test hypotheses, and gain insights into complex social issues.

Law and Ethics

Case studies are used in law and ethics to examine legal and ethical dilemmas. Case studies can help lawyers, policymakers, and ethical professionals to develop critical thinking skills, analyze complex cases, and make informed decisions.

Purpose of Case Study

The purpose of a case study is to provide a detailed analysis of a specific phenomenon, issue, or problem in its real-life context. A case study is a qualitative research method that involves the in-depth exploration and analysis of a particular case, which can be an individual, group, organization, event, or community.

The primary purpose of a case study is to generate a comprehensive and nuanced understanding of the case, including its history, context, and dynamics. Case studies can help researchers to identify and examine the underlying factors, processes, and mechanisms that contribute to the case and its outcomes. This can help to develop a more accurate and detailed understanding of the case, which can inform future research, practice, or policy.

Case studies can also serve other purposes, including:

• Illustrating a theory or concept: Case studies can be used to illustrate and explain theoretical concepts and frameworks, providing concrete examples of how they can be applied in real-life situations.
• Developing hypotheses: Case studies can help to generate hypotheses about the causal relationships between different factors and outcomes, which can be tested through further research.
• Providing insight into complex issues: Case studies can provide insights into complex and multifaceted issues, which may be difficult to understand through other research methods.
• Informing practice or policy: Case studies can be used to inform practice or policy by identifying best practices, lessons learned, or areas for improvement.

Advantages of Case Study Research

There are several advantages of case study research, including:

• In-depth exploration: Case study research allows for a detailed exploration and analysis of a specific phenomenon, issue, or problem in its real-life context. This can provide a comprehensive understanding of the case and its dynamics, which may not be possible through other research methods.
• Rich data: Case study research can generate rich and detailed data, including qualitative data such as interviews, observations, and documents. This can provide a nuanced understanding of the case and its complexity.
• Holistic perspective: Case study research allows for a holistic perspective of the case, taking into account the various factors, processes, and mechanisms that contribute to the case and its outcomes. This can help to develop a more accurate and comprehensive understanding of the case.
• Theory development: Case study research can help to develop and refine theories and concepts by providing empirical evidence and concrete examples of how they can be applied in real-life situations.
• Practical application: Case study research can inform practice or policy by identifying best practices, lessons learned, or areas for improvement.
• Contextualization: Case study research takes into account the specific context in which the case is situated, which can help to understand how the case is influenced by the social, cultural, and historical factors of its environment.

Limitations of Case Study Research

There are several limitations of case study research, including:

• Limited generalizability : Case studies are typically focused on a single case or a small number of cases, which limits the generalizability of the findings. The unique characteristics of the case may not be applicable to other contexts or populations, which may limit the external validity of the research.
• Biased sampling: Case studies may rely on purposive or convenience sampling, which can introduce bias into the sample selection process. This may limit the representativeness of the sample and the generalizability of the findings.
• Subjectivity: Case studies rely on the interpretation of the researcher, which can introduce subjectivity into the analysis. The researcher’s own biases, assumptions, and perspectives may influence the findings, which may limit the objectivity of the research.
• Limited control: Case studies are typically conducted in naturalistic settings, which limits the control that the researcher has over the environment and the variables being studied. This may limit the ability to establish causal relationships between variables.
• Time-consuming: Case studies can be time-consuming to conduct, as they typically involve a detailed exploration and analysis of a specific case. This may limit the feasibility of conducting multiple case studies or conducting case studies in a timely manner.
• Resource-intensive: Case studies may require significant resources, including time, funding, and expertise. This may limit the ability of researchers to conduct case studies in resource-constrained settings.

About the author

Muhammad Hassan

Researcher, Academic Writer, Web developer

You may also like

One-to-One Interview – Methods and Guide

Exploratory Research – Types, Methods and...

Research Methods – Types, Examples and Guide

Ethnographic Research -Types, Methods and Guide

Quantitative Research – Methods, Types and...

Qualitative Research Methods

Masters Compare - Find your perfect masters course.

• Studying a Postgraduate degree

How to use a case study in your masters dissertation

Share this article.

• Facebook Sharer
• Twitter Sharer
• LinkedIn Sharer

Explore other topics

• Funding a Postgraduate course
• Living as a Postgraduate student
• Popular masters degree subjects
• Student Wellbeing
• Finding a PhD or Masters Course

Think Postgrad

Frequently asked questions.

Yes, in fact a case study is a very good option in your dissertation. There are multiple ways to implement a case study in your thesis. For instance, one main study which is in depth and complex or you could feature multiple case studies.

Case studies are a way to research a particular field, group, people and situation. The topic of research is studied deeply and thoroughly in order to solve a problem or uncover information. Case studies are a type of qualitative research.

If you are ready to find a masters course check out Masters Compare.

Prof Martyn Denscombe, author of “ The Good Research Guide, 6th edition ”, gives expert advice on how to use a case study in your masters dissertation. 

There are two main examples for how to use a case study in your masters dissertation, namely quantitative and qualitative case studies.

First, a case study provides a platform that allows you to study a situation in depth and produce the level of academic inquiry that is expected in a master’s degree. In the context of any master’s programme the dissertation operates as something of a showcase for a student’s abilities.

It can easily make the difference between getting a merit and a distinction in the final award of degree. It is important, therefore, to base the work on an approach that allows things to be explored in sufficient depth and detail to warrant a good grade.

Second, case studies can be useful in a practical sense. It is possible to complete a case study in a relatively short period of intense study and so it is the kind of research that is feasible in terms of the kind of time constraints that face master’s students as they enter the final stages of their programme of study.

Added to which a case study can also be a rather convenient form of research, avoiding the time and costs of travel to multiple research sites. The use of case studies, then, would appear to be an attractive proposition. But it is not an approach that should be used naively without consideration of its limitations or potential pitfalls.

To be a good case study the research needs to consider certain key issues. If they are not addressed it will considerably lower the value of the master’s degree. For instance, a good case study needs to:

• Be crystal clear about the purpose for which the research is being conducted
• Justify the selection of the particular case being studied
• Describe how the chosen case compares with others of its type
• Explain the basis on which any generalizations can be made from the findings

This is where The Good Research Guide, 6th edition becomes so valuable. It not only identifies the key points that need to be addressed in order to conduct a competent questionnaire survey.

It gets right to the heart of the matter with plenty of practical guidance on how to deal with issues. Using plain language, this bestselling book covers a range of alternative strategies and methods for conducting small-scale social research projects. It outlines some of the main ways in which the data can be analysed.

Read Prof Martyn Denscombe’s advice on using a questionnaire survey for your postgraduate dissertation

• Advertisers
• Cookie Policy
• Terms and Conditions

Sorry! You need to sign up

Sign up to Postgraduate Studentships

Sign up to compare masters

Opportunity added!

Thanks for making your selection. Click below to view your list.

Course Added

Thanks for making your selection. Click below to view your comparisons.

Think Postgrad Ltd 2008-2024 Website By Parachute

Browser does not support script.

• Departments and Institutes
• Research centres and groups
• Chair's Blog: Summer Term 2022
• Staff wellbeing

Methodology - Developing post-graduate research skills

Phoebe Bui (MY428 student – 2018/2019)

Writing the blog post gave us the opportunity to strengthen and diversify our communicative skills in an encouraging, but also interdisciplinary environment. I have no doubt that I have become a better, more persuasive, more accessible researcher because of it.

Nicolette Foo (MY428 student – 2018/2019) -

... the peer feedback exercise showed me that I had taken certain knowledge for granted due to familiarity with my own project and its context, improving how I communicate my project to make it clear for my potential audience.

Audrey Alejandro

Methodology

How to effectively prepare post-graduate students to become autonomous and confident in developing their own research project? Combining a blog-post, a project outline and peer-feedback in the formative assignment equips students with key graduate attributes focusing on communication, structure, coherence, and self-assessment, as well as creates a feeling of community within the course.

Target audience

MY428/528 Qualitative Text and Discourse Analysis is a post-graduate course that has proven popular with students from across the School. In its first year (2018/19), it was taken by students from the departments of Sociology, Gender, Law, Anthropology, Methodology, Geography, Media and Communications, Accounting, and the European Institute.

The course is an initiation into research which focuses on the acquisition of qualitative text/discourse analysis and related research design skills, through 4000 word research project including a pilot analysis that students often use as a basis for their Msc/PhD dissertation. The course is based on an active learning and ‘learning by doing’ approach. The first part is an introduction and hands-on application of specific analytical methods to qualitative data. The second part places the in-depth analysis of texts in the broader context of research methodology and the construction of a research project.

The formative assignment is submitted between the first and second part of the module (reading week). It focuses on the topic that the student will develop in their summative assignment and comprises two elements. The first element is a 500 word long blog post to be uploaded on a Moodle blog created for the course. The aim of the blog post is to develop students’ communication skills. The objective is to convince the rest of the class that the research problem is a relevant question that needs to be asked, as well as to improve clarity and accessibility beyond the specialist audience. Blog posts should comprise 6 dimensions in (Relevance, Contextualisation, Originality, Puzzle/Paradox, Textual/Discursive dimensions, Research question) and students are incentivised to make their post more appealing by using images and catchy titles.

The second element of the formative assignment is a project outline that aims to guide students in critically assessing the structure and coherence of their project. The objective is to ensure students understand the complementary role played by the different sections of a research project and how to make sure all these sections are theoretically, methodologically and empirically aligned to pursue an identified goal. Students are asked to fill in a one-page synthetic template in a “make-or-break” table that prevents them from hiding their uncertainties regarding their methodological choices behind long sentences and paragraphs.

Detailed instructions regarding expectations are communicated via the course guide and in the lecture (30min) two weeks before the deadline. Besides receiving individual feedback from the teacher, students receive peer feedback in a dedicated seminar two weeks after submission. To guide the seminar, students are given criteria that they should be looking for (adapted from the criteria of evaluation given prior to submission) and exchange roles every 20 minutes (between giving and behind given feedback).

I developed this exercise as I felt postgraduate students were paradoxically not guided enough in addressing major issues recurring in research projects that I had assessed (i.e. how to demonstrate the relevance of a topic to a non-specialist audience and structure more coherently the different dimensions of the project) while at the same time not given the chance to outgrow their undergraduate student identity and become confident to speak in their own voice. I wanted to enable students to acquire the skills they needed to speak as  junior researchers and share the knowledge they create to a multidisciplinary audience (rather than speaking as only students writing a paper for their teachers). Also, I wanted to give students the feeling that they were not isolated in their research struggle and that they could be proud of the progress they made so far, by experiencing first-hand the collective issues and achievements of the cohort.

The realisation by students that they could develop projects at the postgraduate level that would interest and engage their peers represented a shift in the learning environment with a greater level of participation in class. As I implemented this formative assignment the first year I taught this module I cannot establish a direct comparison with previous years but the levels of communication, structure and coherence present in submissions for this course marked an improvement over other research-based assignments that I had graded so far.

Below are a couple of student testimonials regarding the project: 

“ I’ve found that many research-based courses focus almost entirely on the research process in the abstract. Professor Alejandro shines a light on two element of the process that tend to be overlooked: communication and practice. Who is our audience? Who are we trying to persuade? What are the appropriate mediums to disseminate our research? Writing the blog post gave us the opportunity to strengthen and diversify our communicative skills in an encouraging, but also interdisciplinary environment. I have no doubt that I have become a better, more persuasive, more accessible researcher because of it.  Additionally, drafting a project outline reminded me that research is an iterative process, and it is important and helpful to revise our question and design at multiple points throughout the process. Coming from a different educational background, I truly understood the advantages of having a formative assessment: we were given the opportunity to practice, mess up, revise, and ultimately grow as students and researchers .”

" I found the MY428 formative assignment to be challenging but ultimately very beneficial toward structuring my project and developing transferable skills as a researcher. The blog post made me communicate my ideas in a concise way to appeal to others who do not necessarily share my research interests and reading my fellow students’ blog posts expanded my horizon of the range of social phenomena we can investigate using text/discourse analysis. The research design template was a useful tool to map out the project even in its initial uncertain stages and when I updated the template at a later stage of my project, I was happy to see that my ideas had developed over time (e.g., I was able to identify and define key analytical concepts much more clearly). Finally, the peer feedback exercise showed me that I had taken certain knowledge for granted due to familiarity with my own project and its context, improving how I communicate my project to make it clear for my potential audience. " 

Nicolette Foo (MY428 student – 2018/2019)

I will reconvene the formative assignment next year, refining the instructions to reflect the lessons learned from the first year.

My advice to others who want to do a similar intervention would be to develop an awareness of its objective from the very beginning of the course, and to foster and develop an interest and enthusiasm for it by embedding its central message throughout all the teaching (rather than simply around the time of assignment submission). By encouraging students to internalise these objectives throughout the course, the assignment appears less as an ad hoc ‘task’ to complete and more as a natural milestone where students can assess for themselves what they have acquired in their learning path.

Back to LSE Education Case Studies

Academia.edu no longer supports Internet Explorer.

To browse Academia.edu and the wider internet faster and more securely, please take a few seconds to  upgrade your browser .

Enter the email address you signed up with and we'll email you a reset link.

• We're Hiring!
• Help Center

Appropriate research methods for postgraduate research: a Public Administration case study

Online Journal Abstract Information - Sabinet Online.

Related Papers

Public Administration Review

Mark Rivera

Texas State PA Applied Research Projects

Gerrit Van der Waldt

Theory underpins social science endeavours by providing the philosophical assumptions on the following aspects: aspects that constitute social reality (ontology); is accepted as valid evidence of that reality (epistemology); the means to investigate the context (methodology); and the manner in which evidence is gathered (methods). Both positivists and interpretivists generally concur that theory occupies a central role in scientific inquiry into the social world. In disciplines of applied social science such as Public Administration, research generally fosters the transition from theory to practice. In this respect, theory underlies the designs, methods, and findings of the research process.

Journal of Public Administration Research and Theory

Kenneth Meier

Dvora Yanow

Scientific conversations can be riddled with confusion when contributions to the discussion are based on notions about ways of knowing that remain implicit. Researchers often mix different methodological positions in their research designs due to their lack of awareness of distinctions between different ways of knowing and their associated methods. We engage and reflect on these differences, with particular attention to four areas: research question formulations, the character and role of concepts and theories, hypotheses versus puzzles, and case study research. We call on all researchers, including both academics and practitioners, to be aware of the ways in which scientific terms serve, in research debates, as signifiers of different logics of inquiry. Awareness of these differences is important for the sake of productive scientific discussions and for the logical consistency of research, as both of the ways of knowing that we discuss are legitimate scientific endeavors, albeit invoking different evaluative criteria.

Jacobus S Wessels

This article argues that the findings of South African research in Public Administration are often not relevant due to research purposes that imply a combination of predominantly descriptive research, textual data sources and reading as research method. Against the background of the relevancy discourse in Public Administration, this article suggests methodological criteria for determining the relevance of research. Subsequently, scholarly articles in three peer-reviewed journals as well as doctoral theses in the period 2000–2005 were surveyed to assess the consistency between research topic, research purpose, units of observation and research methods. The current study found that thesis research is methodological consistent while articles lack consistency. Scholarly articles seem thus to lack relevancy to the needs of practice.

Purpose The purpose of this research project is three fold. The first purpose is to review the literature that addresses the problems associated with research in public administration and the quality of methodology in public administration using criteria from the literature. Second the educational pedagogy used to supervise the Applied Research Projects (ARPs) at Texas State University is examined. Finally, the actual Texas State ARPs from 1999-2005 are described. Method The analysis of ARPs is completed using content analysis. Content analysis is used because it involves a direct examination of the documents. Content analysis has been the methodology of choice for critiquing public administration research (see Perry and Kraemer (1986), Houston and Delevan (1990), Adams and White (1994), McCurdy and Cleary (1984), Gute (1999), Almaguel (1997), Nall (1994), and Beck (1993)). Findings When comparing Texas State Applied Research Project to the previous authors (Gute1999 and Almaguel 1997) the ARPs have similarities as well as a few differences. Some of the major similarities are that the ARPs do have clearly stated purposes and use conceptual frameworks. Some of the major differences are the average size of the ARPs have decreased. Also, the ARPs from 1999-2005 focus more on state government than local or national government as shown by the previous two authors. The remaining findings are discussed in the conclusion chapter of this research.

Springer eBooks

Susan Kilonzo

Journal of Public Affairs Education

Roy Heidelberg

RELATED PAPERS

永久可查aston毕业证书 英国阿斯顿大学毕业证学位证书样板Leter Offer原版一模一样

Public Choice

Richard J . Cebula

Horticulturae

Stefano La Malfa

평택출장안마『카아톡NW30 』ル「SOD30.NET」평택출장샵ル평택출장아가씨ル평택출장샵ル평택출장마사지ル평택모텔출장ル평택출장샵추천

TijbSC wxza

hjhfggf hjgfdf

DOAJ (DOAJ: Directory of Open Access Journals)

Niloofar Javanrouh

Journal of the American College of Cardiology

Nesim Aladağ

hgtyfrf fggfhhfg

2017 10th International Symposium on Advanced Topics in Electrical Engineering (ATEE)

Aurelian Craciunescu

Lsa778 新 泽 西 理 工 学 院 假 毕 业 证 li

Carbohydrate Polymers

Mike Gidley

AIP Advances

nouman sarwar

The Journal of Neuroscience

Michael Heneka

IEEE Transactions on Microwave Theory and Techniques

Journal of Polymer Research

Fuqian Yang

Journal of Algebra and Its Applications

Ruvim Lipyanski

哪里购买ua毕业证书 加拿大阿尔伯塔大学毕业证文凭证书英文原版一模一样

RUTH CAVALCANTI GUILHERME

International Journal of Current Microbiology and Applied Sciences

Dr. A.S. Mailappa, CHF, CAU, Pasighat

Mattia Fumagalli

•   We're Hiring!
•   Help Center
• Find new research papers in:
• Health Sciences
• Earth Sciences
• Cognitive Science
• Mathematics
• Computer Science
• Academia ©2024

• Open access
• Published: 30 May 2024

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

• Rebecca L. Jones 1 , 2 ,
• Suwimol Prusmetikul 1 , 3 &
• Sarah Whitehorn 1  

BMC Medical Education volume  24 , Article number:  597 ( 2024 ) Cite this article

119 Accesses

Metrics details

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.

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.

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.

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.

Peer Review reports

Diversity in the surgical workforce has been a hot topic for the last 10 years, increasing in traction following the BlackLivesMatter movement in 2016 [ 1 ]. In the UK this culminated in publication of the Kennedy report in 2021 [ 2 ]. Before this the focus was principally on gender imbalance in surgery, with the 2010 Surgical Workforce report only reporting gender percentages by speciality, with no comment on racial profile, sexuality distribution, disability occurrence, or socioeconomic background [ 3 ].

Gender is not the only protected characteristic deserving of equity in surgery; many groups find themselves at a disadvantage during postgraduate surgical examinations [ 4 ] and at revalidation [ 5 ]. This phenomenon is termed ‘differential attainment’ (DA), in which disparities in educational outcomes, progression rates, or achievements between groups with protected characteristics occur [ 4 ]. This may be due to the assessors’ subconscious bias, or a deficit in training and education before assessment.

One of the four pillars of medical ethics is “justice”, emphasising that healthcare should be provided in a fair, equitable, and ethical manner, benefiting all individuals and promoting the well-being of society as a whole. This applies not only to our patients but also to our colleagues; training should be provided in a fair, equitable, and ethical manner, benefiting all. By applying the principle of justice to surgical trainees, we can create an environment that is supportive, inclusive, and conducive to professional growth and well-being.

A diverse consultant body is crucial for providing high-quality healthcare to a diverse patient population. It has been shown that patients are happier when cared for by a doctor with the same ethnic background [ 6 ]. Takeshita et al. [ 6 ] proposed this is due to a greater likelihood of mutual understanding of cultural values, beliefs, and preferences and is therefore more likely to cultivate a trusting relationship, leading to accurate diagnosis, treatment adherence and improved patient understanding. As such, ensuring that all trainees are justly educated and assessed throughout their training may contribute to improving patient care by diversifying the consultant body.

Surgery is well known to have its own specific culture, language, and social rules which are unique even within the world of medicine [ 7 , 8 ]. Through training, graduates develop into surgeons, distinct from other physicians and practitioners [ 9 ]. As such, research conducted in other medical domains is not automatically applicable to surgery, and behavioural interventions focused on reducing or eliminating bias in training need to be tailored specifically to surgical settings.

Consequently, it’s important that the surgical community asks the questions:

Does DA exist in postgraduate surgical training, and to what extent?

Why does DA occur?

What groups or assessments are under-researched?

How can we apply this knowledge, or acquire new knowledge, to provide equity for trainees?

The following scoping review hopes to provide the surgical community with robust answers for future of surgical training.

Aims and research question

The aim of this scoping review is to understand the breadth of research about the presence of DA in postgraduate surgical education and to determine themes pertaining to causes of inequalities. A scoping review was chosen to provide a means to map the available literature, including published peer-reviewed primary research and grey literature.

Following the methodological framework set out by Arksey and O’Malley [ 10 ], our research was intended to characterise the literature addressing DA in HST, including Ophthalmology, Obstetrics & Gynaecology (O&G). We included literature from English-language speaking countries, including the UK and USA.

Search strategy

We used search terms tailored to our target population characteristics (e.g., gender, ethnicity), concept (i.e., DA) and context (i.e., assessment in postgraduate surgical education). Medline and Embase were searched with the assistance of a research librarian, with addition of synonyms. This was conducted in May 2023, and was exported to Microsoft Excel for further review. The reference lists of included articles were also searched to find any relevant data sources that had yet to be considered. In addition, to identify grey literature, a search was performed for the term “differential attainment” and “disparity” on the relevant stakeholders’ websites (See supplemental Table 1 for full listing). Stakeholders were included on the basis of their involvement in governance or training of surgical trainees.

Study selection

To start we excluded conference abstracts that were subsequently published as full papers to avoid duplications ( n  = 337). After an initial screen by title to exclude obviously irrelevant articles, articles were filtered to meet our inclusion and exclusion criteria (Table  1 ). The remaining articles ( n  = 47) were then reviewed in their entirety, with the addition of five reports found in grey literature. Following the screening process, 45 studies were recruited for scoping review (Fig.  1 ).

Charting the data

The extracted data included literature title, authors, year of publication, country of study, study design, population characteristic, case number, context, type of assessment, research question and main findings (Appendix 1). Extraction was performed initially by a single author and then subsequently by a second author to ensure thorough review. Group discussion was conducted in case of any disagreements. As charting occurred, papers were discovered within reference lists of included studies which were eligible for inclusion; these were assimilated into the data charting table and included in the data extraction ( n  = 8).

Collating, summarizing and reporting the results

The included studies were not formally assessed in their quality or risk of bias, consistent with a scoping review approach [ 10 ]. However, group discussion was conducted during charting to aid argumentation and identify themes and trends.

We conducted a descriptive numerical summary to describe the characteristics of included studies. Then thematic analysis was implemented to examine key details and organise the attainment quality and population characteristics based on their description. The coding of themes was an iterative process and involved discussion between authors, to identify and refine codes to group into themes.

We categorised the main themes as gender, ethnicity, country of graduation, individual and family background in education, socioeconomic background, age, and disability. The number of articles in each theme is demonstrated in Table  2 . Data was reviewed and organised into subtopics based on assessment types included: academic achievement (e.g., MRCS, FRCS), assessments for progression (e.g., ARCP), workplace-based assessment (e.g., EPA, feedback), surgical experience (e.g., case volume), and technical skills (e.g., visuo-spatial tasks).

PRISMA flow diagram

44 articles defined the number of included participants (89,399 participants in total; range of participants across individual studies 16–34,755). Two articles reported the number of included studies for their meta-analysis (18 and 63 included articles respectively). Two reports from grey literature did not define the number of participants they included in their analysis. The characteristics of the included articles are displayed in Table  2 .

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

Academic achievement

In the American Board of Surgery Certifying Exam (ABSCE), Maker [ 11 ] found there to be no significant differences in terms of gender when comparing those who passed on their first attempt and those who did not in general surgery training, a finding supported by Ong et al. [ 12 ]. Pico et al. [ 13 ] reported that in Orthopaedic training, Orthopaedic In-Training Examination (OITE) and American Board of Orthopaedic Surgery (ABOS) Part 1 scores were similar between genders, but that female trainees took more attempts in order to pass. In the UK, two studies reported significantly lower Membership of the Royal College of Surgeons (MRCS) pass rates for female trainees compared to males [ 4 , 14 ]. However, Robinson et al. [ 15 ] presented no significant gender differences in MRCS success rates. A study assessing Fellowship of the Royal College of Surgeons (FRCS) examination results found no significant gender disparities in pass rates [ 16 ]. In MRCOG examination, no significant gender differences were found in Part 1 scores, but women had higher pass rates and scores in Part 2 [ 17 ].

Assessment for Progression

ARCP is the annual process of revalidation that UK doctors must perform to progress through training. A satisfactory progress outcome (“outcome 1”) allows trainees to advance through to the next training year, whereas non-satisfactory outcomes (“2–5”) suggest inadequate progress and recommends solutions, such as further time in training or being released from the training programme. Two studies reported that women received 60% more non-satisfactory outcomes than men [ 16 , 18 ]. In contrast, in O&G men had higher non-satisfactory ARCP outcomes without explicit reasons for this given [ 19 ].

Regarding Milestone evaluations based from the US Accreditation Council for Graduate Medical Education (ACGME), Anderson et al. [ 20 ] reported men had higher ratings of knowledge of diseases at postgraduate year 5 (PGY-5), while women had lower mean score achievements. This was similar to another study finding that men and women had similar competencies at PGY-1 to 3, and that it was only at PGY-5 that women were evaluated lower than men [ 21 ]. However, Kwasny et al. [ 22 ] found no difference in trainers’ ratings between genders, but women self-rated themselves lower. Salles et al. [ 23 ] demonstrated significant improvement in scoring in women following a value-affirmation intervention, while this intervention did not affect men.

Workplace-based Assessment

Galvin et al. [ 24 ] reported better evaluation scores from nurses for PGY-2 male trainees, while females received fewer positive and more negative comments. Gerull et al. [ 25 ] demonstrated men received compliments with superlatives or standout words, whereas women were more likely to receive compliments with mitigating phrases (e.g., excellent vs. quite competent).

Hayward et al. [ 26 ] investigated assessment of attributes of clinical performance (ethics, judgement, technical skills, knowledge and interpersonal skills) and found similar scoring between genders.

Several authors have studied autonomy given to trainees in theatre [ 27 , 28 , 29 , 30 , 31 ]. Two groups found no difference in level of granted autonomy between genders but that women rated lower perceived autonomy on self-evaluation [ 27 , 28 ]. Other studies found that assessors consistently gave female trainees lower autonomy ratings, but only in one paper was this replicated in lower performance scores [ 29 , 30 , 31 ].

Padilla et al. [ 32 ] reported no difference in entrustable professional activity assessment (EPA) levels between genders, yet women rated themselves much lower, which they regarded as evidence of imposter syndrome amongst female trainees. Cooney et al. [ 33 ] found that male trainers scored EPAs for women significantly lower than men, while female trainers rated both genders similarly. Conversely, Roshan et al. [ 34 ] found that male assessors were more positive in feedback comments to female trainees than male trainees, whereas they also found that comments from female assessors were comparable for each gender.

Surgical Experience

Gong et al. [ 35 ] found significantly fewer cataract operations were performed by women in ophthalmology residency programmes, which they suggested could be due to trainers being more likely to give cases to male trainees. Female trainees also participated in fewer robotic colorectal procedures, with less operative time on the robotic console afforded [ 36 ]. Similarly, a systematic review highlighted female trainees in various specialties performed fewer cases per week and potentially had limited access to training facilities [ 37 ]. Eruchalu et al. [ 38 ] found that female trainees performed fewer cases, that is, until gender parity was reached, after which case logs were equivalent.

Technical skills

Antonoff et al. [ 39 ] found higher scores for men in coronary anastomosis skills, with women receiving more “fail” assessments. Dill-Macky et al. [ 40 ] analysed laparoscopic skill assessment using blinded videos of trainees and unblinded assessments. While there was no difference in blinded scores between genders, when comparing blinded and unblinded scores individually, assessors were less likely to agree on the scores of women compared to men. However, another study about laparoscopic skills by Skjold-Ødegaard et al. [ 41 ] reported higher performance scores in female residents, particularly when rated by women. The lowest score was shown in male trainees rated by men. While some studies showed disparities in assessment, several studies reported no difference in technical skill assessments (arthroscopic, knot tying, and suturing skills) between genders [ 42 , 43 , 44 , 45 , 46 ].

Several studies investigated trainees’ abilities to complete isolated tasks associated with surgical skills. In laparoscopic tasks, men were initially more skilful in peg transfer and intracorporeal knot tying than women. Following training, the performance was not different between genders [ 47 ]. A study on microsurgical skills reported better initial visual-spatial and perceptual ability in men, while women had better fine motor psychomotor ability. However, these differences were not significant, and all trainees improved significantly after training [ 48 ]. A study by Milam et al. [ 49 ] revealed men performed better in mental rotation tasks and women outperformed in working memory. They hypothesised that female trainees would experience stereotype threat, fear of being reduced to a stereotype, which would impair their performance. They found no evidence of stereotype threat influencing female performance, disproving their hypothesis, a finding supported by Myers et al. [ 50 ].

Ethnicity and country of graduation

Most papers reported ethnicity and country of graduation concurrently, for example grouping trainees as White UK graduates (WUKG), Black and minority ethnicity UK graduates (BME UKG), and international medical graduates (IMG). Therefore, these areas will be addressed together in the following section.

When assessing the likelihood of passing American Board of Surgery (ABS) examinations on first attempt, Yeo et al. [ 51 ] found that White trainees were more likely than non-White. They found that the influence of ethnicity was more significant in the end-of-training certifying exam than in the start-of-training qualifying exam. This finding was corroborated in a study of both the OITE and ABOS certifying exam, suggesting widening inequalities during training [ 52 ].

Two UK-based studies reported significantly higher MRCS pass rates in White trainees compared to BMEs [ 4 , 14 ]. BMEs were less likely to pass MRCS Part A and B, though this was not true for Part A when variations in socioeconomic background were corrected for [ 14 ]. However, Robinson et al. [ 53 ] found no difference in MRCS pass rates based on ethnicity. Another study by Robinson et al. [ 15 ] demonstrated similar pass rates between WUKGs and BME UKGs, but IMGs had significantly lower pass rates than all UKGs. The FRCS pass rates of WUKGs, BME UKGs and IMGs were 76.9%, 52.9%, and 53.9%, respectively, though these percentages were not statistically significantly different [ 16 ].

There was no difference in MRCOG results based on ethnicity, but higher success rates were found in UKGs [ 19 ]. In FRCOphth, WUKGs had a pass rate of 70%, higher than other groups of trainees, with a pass rate of only 45% for White IMGs [ 52 ].

By gathering data from training programmes reporting little to no DA due to ethnicity, Roe et al. [ 54 ] were able to provide a list of factors they felt were protective against DA, such as having supportive supervisors and developing peer networks.

Assessment for progression

RCOphth [ 55 ] found higher rates of satisfactory ARCP outcomes for WUKGs compared to BME UKGs, followed by IMGs. RCOG [ 19 ] discovered higher rates of non-satisfactory ARCP outcomes from non-UK graduates, particularly amongst BMEs and those from the European Economic Area (EEA). Tiffin et al. [ 56 ] considered the difference in experience between UK graduates and UK nationals whose primary medical qualification was gained outside of the UK, and found that the latter were more likely to receive a non-satisfactory ARCP outcome, even when compared to non-UK nationals.

Woolf et al. [ 57 ] explored reasons behind DA by conducting interview studies with trainees. They investigated trainees’ perceptions of fairness in evaluation and found that trainees felt relationships developed with colleagues who gave feedback could affect ARCP results, and might be challenging for BME UKGs and IMGs who have less in common with their trainers.

Workplace-based assessment

Brooks et al. [ 58 ] surveyed the prevalence of microaggressions against Black orthopaedic surgeons during assessment and found 87% of participants experienced some level of racial discrimination during workplace-based performance feedback. Black women reported having more racially focused and devaluing statements from their seniors than men.

Surgical experience

Eruchalu et al. [ 38 ] found that white trainees performed more major surgical cases and more cases as a supervisor than did their BME counterparts.

Dill-Macky et al. [ 40 ] reported no significant difference in laparoscopic surgery assessments between ethnicities.

Individual and family background in education

Two studies [ 4 , 16 ] concentrated on educational background, considering factors such as parental occupation and attendance of a fee-paying school. MRCS part A pass rate was significantly higher for trainees for whom Medicine was their first Degree, those with university-educated parents, higher POLAR (Participation In Local Areas classification group) quintile, and those from fee-paying schools. Higher part B pass rate was associated with graduating from non-Graduate Entry Medicine programmes and parents with managerial or professional occupations [ 4 ]. Trainees with higher degrees were associated with an almost fivefold increase in FRCS success and seven times more scientific publications than their counterparts [ 16 ].

Socioeconomic background

Two studies used Index of Multiple Deprivation quintile, the official measure of relative deprivation in England based on geographical areas for grading socioeconomic level. The area was defined at the time of medical school application. Deprivation quintiles (DQ) were calculated, ranging from DQ1 (most deprived) to DQ5 (least deprived) [ 4 , 14 ].

Trainees with history of less deprivation were associated with higher MRCS part A pass rate. More success in part B was associated with history of no requirement for income support and less deprived areas [ 4 ]. Trainees from DQ1 and DQ2 had lower pass rates and higher number of attempts to pass [ 14 ]. A general trend of better outcomes in examination was found from O&G trainees in less deprived quintiles [ 19 ].

Trainees from DQ1 and DQ2 received significantly more non-satisfactory ARCP outcomes (24.4%) than DQ4 and DQ5 (14.2%) [ 14 ].

Trainees who graduated at age less than 29 years old were more likely to pass MRCS than their counterparts [ 4 ].

Authors [ 18 , 56 ] found that older trainees received more non-satisfactory ARCP outcomes. Likewise, there was higher percentage of non-satisfactory ARCP outcomes in O&G trainees aged over 45 compared with those aged 25–29 regardless of gender [ 19 ].

Trainees with disability had significantly lower pass rates in MRCS part A compared to candidates without disability. However, the difference was not significant for part B [ 59 ].

What have we learnt from the literature?

It is heartening to note the recent increase in interest in DA (27 studies in the last 4 years, compared to 26 in the preceding 40) (Fig.  2 ). The vast majority (77%) of studies are quantitative, based in the US or UK (89%), focus on gender (85%) and relate to clinical assessments (51%) rather than examination results. Therefore, the surgical community has invested primarily in researching the experience of women in the USA and UK.

Interestingly, a report by RCOG [ 19 ] showed that men were more likely to receive non-satisfactory ARCP outcomes than women, and a study by Rushd et al. [ 17 ] found that women were more likely to pass part 2 of MRCOG than men. This may be because within O&G men are the “out-group” (a social group or category characterised by marginalisation or exclusion by the dominant cultural group) as 75% of O&G trainees are female [ 60 ].

This contrasts with other specialities in which men are the in-group and women are seen to underperform. Outside of O&G, in comparison to men, women are less likely to pass MRCS [ 4 , 14 ], receive satisfactory ARCP outcome [ 16 , 18 ], or receive positive feedback [ 24 ], whilst not performing the same number of procedures as men [ 34 , 35 ]. This often leads to poor self-confidence in women [ 32 ], which can then worsen performance [ 21 ].

It proves difficult to comment on DA for many groups due to a lack of evidence. The current research suggests that being older, having a disability, graduate entry to medicine, low parental education, and living in a lower socioeconomic area at the time of entering medical school are all associated with lower MRCS pass rates. Being older and having a lower socioeconomic background are also associated with non-satisfactory ARCP outcomes, slowing progression through training.

These characteristics may provide a compounding negative effect – for example having a previous degree will automatically make a trainee older, and living in a lower socioeconomic area makes it more likely their parents will have a non-professional job and not hold a higher degree. When multiple protected characteristics interact to produce a compounded negative effect for a person, it is often referred to as “intersectional discrimination” or “intersectionality” [ 61 ]. This is a concept which remains underrepresented in the current literature.

The literature is not yet in agreement over the presence of DA due to ethnicity. There are many studies that report perceived discrimination, however the data for exam and clinical assessment outcomes is equivocal. This may be due to the fluctuating nature of in-groups and out-groups, and multiple intersecting characteristics. Despite this, the lived experience of BME surgeons should not be ignored and requires further investigation.

What are the gaps in the literature?

The overwhelming majority of literature exploring DA addresses issues of gender, ethnicity or country of medical qualification. Whilst bias related to these characteristics is crucial to recognise, studies into other protected characteristics are few and far between. The only paper on disability reported striking differences in attainment between disabled and non-disabled registrars [ 59 ]. There has also been increased awareness about neurodiversity amongst doctors and yet an exploration into the experience of neurodiverse surgeons and their progress through training has yet to be published [ 62 ].

The implications of being LGBTQ + in surgical training have not been recognised nor formally addressed in the literature. Promisingly, the experiences of LGBTQ + medical students have been recognised at an undergraduate level, so one can hope that this will be translated into postgraduate education [ 63 , 64 ]. While this is deeply entwined with experiences of gender discrimination, it is an important characteristic that the surgical community would benefit from addressing, along with disability. To a lesser extent, the effect of socioeconomic background and age have also been overlooked.

Characterising trainees for the purpose of research

Ethnicity is deeply personal, self-defined, and may change over time as personal identity evolves, and therefore arbitrarily grouping diverse ethnic backgrounds is unlikely to capture an accurate representation of experiences. There are levels of discrimination even within minority groups; colourism in India means dark-skinned Indians will experience more discrimination than light-skinned Indians, even from those within in their own ethnic group [ 65 ]. Therefore, although the studies included in the scoping review accepted self-definitions of ethnicity, this is likely not enough to fully capture the nuances of bias and discrimination present in society. For example, Ellis et al. [ 4 ] grouped participants as “White”, “Mixed”, “Asian”, “Black” and “Other”, however they could have also assigned a skin tone value such as the NIS Skin Colour Scale [ 66 ], thus providing more detail.

Ethnicity is more than genetic heritage; it is also cultural expression. The experience of an IMG in UK postgraduate training will differ from that of a UKG, an Indian UKG who grew up in India, and an Indian UKG who grew up in the UK. These are important distinctions which are noted in the literature (e.g. by Woolf et al., 2016 [ 57 ]) however some do not distinguish between ethnicity and graduate status [ 15 ] and none delve into an individual’s cultural expression (e.g., clothing choice) and how this affects the perception of their assessors.

Reasons for DA

Despite the recognition of inequalities in all specialties of surgery, there is a paucity of data explicitly addressing why DA occurs. Reasons behind the phenomenon must be explored to enable change and eliminate biases. Qualitative research is more attuned to capturing the complexities of DA through observation or interview-based studies. Currently most published data is quantitative, and relies on performance metrics to demonstrate the presence of DA while ignoring the causes. Promisingly, there are a gradually increasing number of qualitative, predominantly interview-based, studies (Fig.  2 ).

To create a map of DA in all its guises, an analysis of the themes reported to be contributory to its development is helpful. In our review of the literature, four themes have been identified:

Training culture

In higher surgical training, for there to be equality in outcomes, there needs to be equity in opportunities. Ellis et al. [ 4 ] recognised that variation in training experiences, such as accessibility of supportive peers and senior role models, can have implications on attainment. Trainees would benefit from targeted support at times of transition, such as induction or at examinations, and it may be that currently the needs of certain groups are being met before others, reinforcing differential attainment [ 4 ].

Experience of assessment

Most literature in DA relates to the presence (or lack of) an attainment gap in assessments, such as ARCP or MRCS. It is assumed that these assessments of trainee development are objective and free of bias, and indeed several authors have described a lack of bias in these high-stakes examinations (e.g., Ong et al., 2019 [ 12 ]; Robinson et al., 2019 [ 53 ]). However, in some populations, such as disabled trainees, there are differences in attainment [ 59 ]. This is demonstrated despite legislation requiring professional bodies to make reasonable adjustments to examinations for disabled candidates, such as additional time, text formatting amendments, or wheelchair-accessible venues [ 67 ]. Therefore it would be beneficial to investigate the implementation of these adjustments across higher surgical examinations and identify any deficits.

Social networks

Relationships between colleagues may influence DA in multiple ways. Several studies identified that a lack of a relatable and inspiring mentor may explain why female or BME doctors fail to excel in surgery [ 4 , 55 ]. Certain groups may receive preferential treatment due to their perceived familiarity to seniors [ 35 ]. Robinson et al. [ 15 ] recognised that peer-to-peer relationships were also implicated in professional development, and the lack thereof could lead to poor learning outcomes. Therefore, a non-discriminatory culture and inclusion of trainees within the social network of training is posited as beneficial.

Personal characteristics

Finally, personal factors directly related to protected characteristics have been suggested as a cause of DA. For example, IMGs may perform worse in examinations due to language barriers, and those from disadvantaged backgrounds may have less opportunity to attend expensive courses [ 14 , 16 ]. Although it is impossible to exclude these innate deficits from training, we may mitigate their influence by recognising their presence and providing solutions.

The causes of DA may also be grouped into three levels, as described by Regan de Bere et al. [ 68 ]: macro (the implications of high-level policy), meso (focusing on institutional or working environments) and micro (the influence of individual factors). This can intersect with the four themes identified above, as training culture can be enshrined at both an institutional and individual level, influencing decisions that relate to opportunities for trainees, or at a macro level, such as in the decisions made on nationwide recruitment processes. These three levels can be used to more deeply explore each of the four themes to enrich the discovery of causes of DA.

Discussions outside of surgery

Authors in General Practice (e.g., Unwin et al., 2019 [ 69 ]; Pattinson et al., 2019 [ 70 ]), postgraduate medical training (e.g., Andrews, Chartash, and Hay, 2021 [ 71 ]), and undergraduate medical education (e.g., Yeates et al., 2017 [ 72 ]; Woolf et al., 2013 [ 73 ]) have published more extensively in the aetiology of DA. A study by Hope et al. [ 74 ] evaluating the bias present in MRCP exams used differential item functioning to identify individual questions which demonstrated an attainment gap between male and female and Caucasian and non-Caucasian medical trainees. Conclusions drawn about MRCP Part 1 examinations may be generalisable to MRCS Part A or FRCOphth Part 1: they are all multiple-choice examinations testing applied basic science and usually taken within the first few years of postgraduate training. Therefore it is advisable that differential item functioning should also be applied to these examinations. However, it is possible that findings in some subspecialities may not be generalisable to others, as training environments can vary profoundly. The RCOphth [ 55 ] reported that in 2021, 53% of ophthalmic trainees identified as male, whereas in Orthopaedics 85% identified as male, suggesting different training environments [ 5 ]. It is useful to identify commonalities of DA between surgical specialties and in the wider scope of medical training.

Limitations of our paper

Firstly, whilst aiming to provide a review focussed on the experience of surgical trainees, four papers contained data about either non-surgical trainees or medical students. It is difficult to draw out the surgeons from this data and therefore it is possible that there are issues with generalisability. Furthermore, we did not consider the background of each paper’s authors, as their own lived experience of attainment gap could form the lens through which they commented on surgical education, colouring their interpretation. Despite intending to include as many protected characteristics as possible, inevitably there will be lived experiences missed. Lastly, the experience of surgical trainees outside of the English-speaking world were omitted. No studies were found that originated outside of Europe or North America and therefore the presence or characteristics of DA outside of this area cannot be assumed.

Experiences of inequality in surgical assessment are prevalent in all surgical subspecialities. In order to further investigate DA, researchers should ensure all protected characteristics are considered - and how these interact - to gain insight into intersectionality. Given the paucity of current evidence, particular focus should be given to the implications of disability, and specifically neurodiversity, in progress through training as they are yet to be explored in depth. In defining protected characteristics, future authors should be explicit and should avoid generalisation of cultural backgrounds to allow authentic appreciation of attainment gap. Few authors have considered the driving forces between bias in assessment and DA, and therefore qualitative studies should be prioritised to uncover causes for and protective factors against DA. Once these influences have been identified, educational designers can develop new assessment methods that ensure equity across surgical trainees.

Data availability

All data provided during this study are included in the supplementary information files.

Abbreviations

Accreditation Council for Graduate Medical Education

American Board of Orthopaedic Surgery

American Board of Surgery

American Board of Surgery Certifying Exam

Annual Review of Competence Progression

Black, Asian, and Minority Ethnicity

Council on Resident Education in Obstetrics and Gynecology

Differential Attainment

Deprivation Quintile

European Economic Area

Entrustable Professional Activities

Fellowship of The Royal College of Ophthalmologists

Fellow of the Royal College of Surgeons

General Medical Council

Higher Surgical Training

International Medical Graduate

In-Training Evaluation Report

Member of the Royal College of Obstetricians and Gynaecologists

Member of the Royal College of Physicians

Member of the Royal College of Surgeons

Obstetrics and Gynaecology

Orthopaedic In-Training Examination

Participation In Local Areas

Postgraduate Year

The Royal College of Ophthalmologists

The Royal College of Obstetricians and Gynaecologists

The Royal College of Surgeons of England

United Kingdom Graduate

White United Kingdom Graduate

Joseph JP, Joseph AO, Jayanthi NVG, et al. BAME Underrepresentation in Surgery Leadership in the UK and Ireland in 2020: An Uncomfortable Truth. The Bulletin of the Royal College of Surgeons of England. 2020; 102 (6): 232–33.

Royal College of Surgeons of England. The Royal College – Our Professional Home. An independent review on diversity and inclusion for the Royal College of Surgeons of England. Review conducted by Baroness Helena Kennedy QC. RCS England. 2021.

Sarafidou K, Greatorex R. Surgical workforce: planning today for the workforce of the future. Bull Royal Coll Surg Engl. 2011;93(2):48–9. https://doi.org/10.1308/147363511X552575 .

Article   Google Scholar  

Ellis R, Brennan P, Lee AJ, et al. Differential attainment at MRCS according to gender, ethnicity, age and socioeconomic factors: a retrospective cohort study. J R Soc Med. 2022;115(7):257–72. https://doi.org/10.1177/01410768221079018 .

Hope C, Humes D, Griffiths G, et al. Personal Characteristics Associated with Progression in Trauma and Orthopaedic Specialty Training: A Longitudinal Cohort Study.Journal of Surgical Education 2022; 79 (1): 253–59. doi:10.1016/j.jsurg.2021.06.027.

Takeshita J, Wang S, Loren AW, et al. Association of Racial/Ethnic and Gender Concordance Between Patients and Physicians With Patient Experience Ratings. JAMA Network Open. 2022; 3(11). doi:10.1001/jamanetworkopen.2020.24583.

Katz, P. The Scalpel’s Edge: The Culture of Surgeons. Allyn and Bacon, 1999.

Tørring B, Gittell JH, Laursen M, et al. (2019) Communication and relationship dynamics in surgical teams in the operating room: an ethnographic study. BMC Health Services Research. 2019;19, 528. doi:10.1186/s12913-019-4362-0.

Veazey Brooks J & Bosk CL. (2012) Remaking surgical socialization: work hour restrictions, rites of passage, and occupational identity. Social Science & Medicine. 2012;75(9):1625-32. doi: 10.1016/j.socscimed.2012.07.007.

Arksey H & OʼMalley L. Scoping studies: Towards a methodological framework. International Journal of Social Research Methodology. 2005;8(1), 19–32.

Maker VK, Marco MZ, Dana V, et al. Can We Predict Which Residents Are Going to Pass/Fail the Oral Boards? Journal of Surgical Education. 2012;69 (6): 705–13.

Ong TQ, Kopp JP, Jones AT, et al. Is there gender Bias on the American Board of Surgery general surgery certifying examination? J Surg Res. 2019;237:131–5. https://doi.org/10.1016/j.jss.2018.06.014 .

Pico K, Gioe TJ, Vanheest A, et al. Do men outperform women during orthopaedic residency training? Clin Orthop Relat Res. 2010;468(7):1804–8. https://doi.org/10.1007/s11999-010-1318-4 .

Vinnicombe Z, Little M, Super J, et al. Differential attainment, socioeconomic factors and surgical training. Ann R Coll Surg Engl. 2022;104(8):577–82. https://doi.org/10.1308/rcsann.2021.0255 .

Robinson DBT, Hopkins L, James OP, et al. Egalitarianism in surgical training: let equity prevail. Postgraduate Medical Journal. 2020;96 (1141), 650–654. doi:10.1136/postgradmedj-2020-137563.

Luton OW, Mellor K, Robinson DBT, et al. Differential attainment in higher surgical training: scoping pan-specialty spectra. Postgraduate Medical Journal. 2022;99(1174),849–854. doi:10.1136/postgradmedj-2022-141638.

Rushd S, Landau AB, Khan JA, Allgar V & Lindow SW. An analysis of the performance of UK medical graduates in the MRCOG Part 1 and Part 2 written examinations. Postgraduate Medical Journal. 2012;88 (1039), 249–254. doi:10.1136/postgradmedj-2011-130479.

Hope C, Lund J, Griffiths G, et al. Differences in ARCP outcome by surgical specialty: a longitudinal cohort study. Br J Surg. 2021;108. https://doi.org/10.1093/bjs/znab282.051 .

Royal College of Obstetricians and Gynaecologists. Report Differential Attainment 2019. https://www.rcog.org.uk/media/jscgfgwr/differential-attainment-tef-report-2019.pdf [Last accessed 28/12/23].

Anderson JE, Zern NK, Calhoun KE, et al. Assessment of Potential Gender Bias in General Surgery Resident Milestone Evaluations. JAMA Surgery. 2022;157 (12), 1164–1166. doi:10.1001/jamasurg.2022.3929.

Landau SI, Syvyk S, Wirtalla C, et al. Trainee Sex and Accreditation Council for Graduate Medical Education Milestone Assessments during general surgery residency. JAMA Surg. 2021;156(10):925–31. https://doi.org/10.1001/jamasurg.2021.3005 .

Kwasny L, Shebrain S, Munene G, et al. Is there a gender bias in milestones evaluations in general surgery residency training? Am J Surg. 2021;221(3):505–8. https://doi.org/10.1016/j.amjsurg.2020.12.020 .

Salles A, Mueller CM & Cohen GL. A Values Affirmation Intervention to Improve Female Residents’ Surgical Performance. Journal of Graduate Medical Education. 2016;8 (3), 378–383. doi:10.4300/JGME-D-15-00214.1.

Galvin S, Parlier A, Martino E, et al. Gender Bias in nurse evaluations of residents in Obstetrics and Gynecology. Obstet Gynecol. 2015;126(7S–12S). https://doi.org/10.1097/AOG.0000000000001044 .

Gerull KM, Loe M, Seiler K, et al. Assessing gender bias in qualitative evaluations of surgical residents. Am J Surg. 2019;217(2):306–13. https://doi.org/10.1016/j.amjsurg.2018.09.029 .

Hayward CZ, Sachdeva A, Clarke JR. Is there gender bias in the evaluation of surgical residents? Surgery. 1987;102(2):297–9.

Google Scholar  

Cookenmaster C, Shebrain S, Vos D, et al. Gender perception bias of operative autonomy evaluations among residents and faculty in general surgery training. Am J Surg. 2021;221(3):515–20. https://doi.org/10.1016/j.amjsurg.2020.11.016 .

Olumolade OO, Rollins PD, Daignault-Newton S, et al. Closing the Gap: Evaluation of Gender Disparities in Urology Resident Operative Autonomy and Performance.Journal of Surgical Education.2022;79 (2), 524–530. doi.org/10.1016/j.jsurg.2021.10.010.

Chen JX, Chang EH, Deng F, et al. Autonomy in the Operating Room: A Multicenter Study of Gender Disparities During Surgical Training. Journal of Graduate Medical Education. 2021;13(5), 666–672. doi: 10.4300/JGME-D-21-00217.1.

Meyerson SL, Sternbach JM, Zwischenberger JB, & Bender EM. The Effect of Gender on Resident Autonomy in the Operating room. Journal of Surgical Education. 2017. 74(6), e111–e118. doi.org/10.1016/j.jsurg.2017.06.014.

Hoops H, Heston A, Dewey E, et al. Resident autonomy in the operating room: Does gender matter? The AmericanJournalofSurgery. 2019; 217(2), 301–305. doi.org/10.1016/j.amjsurg.2018.12.023.

Padilla EP, Stahl CC, Jung SA, et al. Gender Differences in Entrustable Professional Activity Evaluations of General Surgery Residents. Annals of Surgery. 2022;275 (2), 222–229. doi:10.1097/SLA.0000000000004905.

Cooney CM, Aravind P, Hultman CS, et al. An Analysis of Gender Bias in Plastic Surgery Resident Assessment. Journal of Graduate Medical Education. 2021;13 (4), 500–506. doi:10.4300/JGME-D-20-01394.1.

Roshan A, Farooq A, Acai A, et al. The effect of gender dyads on the quality of narrative assessments of general surgery trainees. The American Journal of Surgery. 2022; 224 (1A), 179–184. doi.org/10.1016/j.amjsurg.2021.12.001.

Gong D, Winn BJ, Beal CJ, et al. Gender Differences in Case Volume Among Ophthalmology Residents. Archives of Ophthalmology. 2019;137 (9), 1015–1020. doi:10.1001/jamaophthalmol.2019.2427.

Foley KE, Izquierdo KM, von Muchow MG, et al. Colon and Rectal Surgery Robotic Training Programs: An Evaluation of Gender Disparities. Diseases of the Colon and Rectum. 2020; 63(7), 974–979. doi.org/10.1097/DCR.0000000000001625.

Ali A, Subhi Y, Ringsted C et al. Gender differences in the acquisition of surgical skills: a systematic review. Surgical Endoscopy. 2015;29 (11), 3065–3073. doi:10.1007/s00464-015-4092-2.

Eruchalu CN, He K, Etheridge JC, et al. Gender and Racial/Ethnic Disparities in Operative Volumes of Graduating General Surgery Residents.The Journal of Surgical Research. 2022; 279, 104–112. doi.org/10.1016/j.jss.2022.05.020.

Antonoff MB, Feldman H, Luc JGY, et al. Gender Bias in the Evaluation of Surgical Performance: Results of a Prospective Randomized Trial. Annals of Surgery. 2023;277 (2), 206–213. doi:10.1097/SLA.0000000000005015.

Dill-Macky A, Hsu C, Neumayer LA, et al. The Role of Implicit Bias in Surgical Resident Evaluations. Journal of Surgical Education. 2022;79 (3), 761–768. doi:10.1016/j.jsurg.2021.12.003.

Skjold-Ødegaard B, Ersdal HL, Assmus J et al. Comparison of Performance Score for Female and Male Residents in General Surgery Doing Supervised Real-Life Laparoscopic Appendectomy: Is There a Norse Shield-Maiden Effect? World Journal of Surgery. 2021;45 (4), 997–1005. doi:10.1007/s00268-020-05921-4.

Leape CP, Hawken JB, Geng X, et al. An investigation into gender bias in the evaluation of orthopedic trainee arthroscopic skills. Journal of Shoulder and Elbow Surgery. 2022;31 (11), 2402–2409. doi:10.1016/j.jse.2022.05.024.

Vogt VY, Givens VM, Keathley CA, et al. Is a resident’s score on a videotaped objective structured assessment of technical skills affected by revealing the resident’s identity? American Journal of Obstetrics and Gynecology. 2023;189 (3), 688–691. doi:10.1067/S0002-9378(03)00887-1.

Fjørtoft K, Konge L, Christensen J et al. Overcoming Gender Bias in Assessment of Surgical Skills. Journal of Surgical Education. 2022;79 (3), 753–760. doi:10.1016/j.jsurg.2022.01.006.

Grantcharov TP, Bardram L, Funch-Jensen P, et al. Impact of Hand Dominance, Gender, and Experience with Computer Games on Performance in Virtual Reality Laparoscopy. Surgical Endoscopy 2003;17 (7): 1082–85.

Rosser Jr JC, Rosser LE & Savalgi RS. Objective Evaluation of a Laparoscopic Surgical Skill Program for Residents and Senior Surgeons. Archives of Surgery. 1998; 133 (6): 657–61.

White MT & Welch K. Does gender predict performance of novices undergoing Fundamentals of Laparoscopic Surgery (FLS) training? The American Journal of Surgery. 2012;203 (3), 397–400. doi:10.1016/j.amjsurg.2011.09.020.

Nugent E, Joyce C, Perez-Abadia G, et al. Factors influencing microsurgical skill acquisition during a dedicated training course. Microsurgery. 2012;32 (8), 649–656. doi:10.1002/micr.22047.

Milam LA, Cohen GL, Mueller C et al. Stereotype threat and working memory among surgical residents. The American Journal of Surgery. 2018;216 (4), 824–829. doi:10.1016/j.amjsurg.2018.07.064.

Myers SP, Dasari M, Brown JB, et al. Effects of Gender Bias and Stereotypes in Surgical Training: A Randomized Clinical Trial. JAMA Surgery. 2020; 155(7), 552–560. doi.org/10.1001/jamasurg.2020.1127.

Yeo HL, Patrick TD, Jialin M, et al. Association of Demographic and Program Factors With American Board of Surgery Qualifying and Certifying Examinations Pass Rates. JAMA Surgery 2020; 155 (1): 22–30. doi:0.1001/jamasurg.2019.4081.

Foster N, Meghan P, Bettger JP, et al. Objective Test Scores Throughout Orthopedic Surgery Residency Suggest Disparities in Training Experience. Journal of Surgical Education 2021;78 (5): 1400–1405. doi:10.1016/j.jsurg.2021.01.003.

Robinson DBT, Hopkins L, Brown C, et al. Prognostic Significance of Ethnicity on Differential Attainment in Core Surgical Training (CST). Journal of the American College of Surgeons. 2019;229 (4), e191. doi:10.1016/j.jamcollsurg.2019.08.1254.

Roe V, Patterson F, Kerrin M, et al. What supported your success in training? A qualitative exploration of the factors associated with an absence of an ethnic attainment gap in post-graduate specialty training. General Medical Council. 2019. https://www.gmc-uk.org/-/media/documents/gmc-da-final-report-success-factors-in-training-211119_pdf-80914221.pdf [Last accessed 28/12/23].

Royal College of Ophthalmologists. Data on Differential attainment in ophthalmology and monitoring equality, diversity, and inclusion: Recommendations to the RCOphth. London, Royal College of Ophthalmologists. 2022. https://www.rcophth.ac.uk/wp-content/uploads/2023/01/Differential-Attainment-Report-2022.pdf [Last accessed 28/12/23].

Tiffin PA, Orr J, Paton LW, et al. UK nationals who received their medical degrees abroad: selection into, and subsequent performance in postgraduate training: a national data linkage study. BMJ Open. 2018;8:e023060. doi: 10.1136/bmjopen-2018-023060.

Woolf K, Rich A, Viney R, et al. Perceived causes of differential attainment in UK postgraduate medical training: a national qualitative study. BMJ Open. 2016;6 (11), e013429. doi:10.1136/bmjopen-2016-013429.

Brooks JT, Porter SE, Middleton KK, et al. The Majority of Black Orthopaedic Surgeons Report Experiencing Racial Microaggressions During Their Residency Training. Clinical Orthopaedics and Related Research. 2023;481 (4), 675–686. doi:10.1097/CORR.0000000000002455.

Ellis R, Cleland J, Scrimgeour D, et al. The impact of disability on performance in a high-stakes postgraduate surgical examination: a retrospective cohort study. Journal of the Royal Society of Medicine. 2022;115 (2), 58–68. doi:10.1177/01410768211032573.

Royal College of Obstetricians & Gynaecologists. RCOGWorkforceReport2022. Available at: https://www.rcog.org.uk/media/fdtlufuh/workforce-report-july-2022-update.pdf [Last accessed 28/12/23].

Crenshaw KW. On Intersectionality: Essential Writings. Faculty Books. 2017; 255.

Brennan CM & Harrison W. The Dyslexic Surgeon. The Bulletin of the Royal College of Surgeons of England. 2020;102 (3): 72–75. doi:10.1308/rcsbull.2020.72.

Toman L. Navigating medical culture and LGBTQ identity. Clinical Teacher. 2019;16: 335–338. doi:10.1111/tct.13078.

Torales J, Castaldelli-Maia JM & Ventriglio A. LGBT + medical students and disclosure of their sexual orientation: more than in and out of the closet. International Review of Psychiatry. 2022;34:3–4, 402–406. doi:10.1080/09540261.2022.2101881.

Guda VA & Kundu RV. India’s Fair Skin Phenomena. SKINmed. 2021;19(3), 177–178.

Massey D & Martin JA. The NIS skin color scale. Princeton University Press. 2003.

Intercollegiate Committee for Basic Surgical Examinations.AccessArrangementsandReasonableAdjustmentsPolicyforCandidateswithaDisabilityorSpecificLearningdifficulty. 2020. https://www.intercollegiatemrcsexams.org.uk/-/media/files/imrcs/mrcs/mrcs-regulations/access-arrangements-and-reasonable-adjustments-january-2020.pdf [Last accessed 28/12/23].

Regan de Bere S, Nunn S & Nasser M. Understanding differential attainment across medical training pathways: A rapid review of the literature. General Medical Council. 2015. https://www.gmc-uk.org/-/media/documents/gmc-understanding-differential-attainment_pdf-63533431.pdf [Last accessed 28/12/23].

Unwin E, Woolf K, Dacre J, et al. Sex Differences in Fitness to Practise Test Scores: A Cohort Study of GPs. The British Journal of General Practice: The Journal of the Royal College of General Practitioners. 2019; 69 (681): e287–93. doi:10.3399/bjgp19X701789.

Pattinson J, Blow C, Sinha B et al. Exploring Reasons for Differences in Performance between UK and International Medical Graduates in the Membership of the Royal College of General Practitioners Applied Knowledge Test: A Cognitive Interview Study. BMJ Open. 2019;9 (5): e030341. doi:10.1136/bmjopen-2019-030341.

Andrews J, Chartash D & Hay S. Gender Bias in Resident Evaluations: Natural Language Processing and Competency Evaluation. Medical Education. 2021;55 (12): 1383–87. doi:10.1111/medu.14593.

Yeates P, Woolf K, Benbow E, et al. A Randomised Trial of the Influence of Racial Stereotype Bias on Examiners’ Scores, Feedback and Recollections in Undergraduate Clinical Exams. BMC Medicine 2017;15 (1): 179. doi:10.1186/s12916-017-0943-0.

Woolf K, McManus IC, Potts HWW et al. The Mediators of Minority Ethnic Underperformance in Final Medical School Examinations. British Journal of Educational Psychology. 2013; 83 (1): 135–59. doi:10.1111/j.2044-8279.2011.02060.x.

Hope D, Adamson K, McManus IC, et al. Using Differential Item Functioning to Evaluate Potential Bias in a High Stakes Postgraduate Knowledge Based Assessment. BMC Medical Education. 2018;18 (1): 64. doi:10.1186/s12909-018-1143-0.

Download references

No sources of funding to be declared.

Author information

Authors and affiliations.

Department of Surgery and Cancer, Imperial College London, London, UK

Rebecca L. Jones, Suwimol Prusmetikul & Sarah Whitehorn

Department of Ophthalmology, Cheltenham General Hospital, Gloucestershire Hospitals NHS Foundation Trust, Alexandra House, Sandford Road, Cheltenham, GL53 7AN, UK

Rebecca L. Jones

Department of Orthopaedics, Faculty of Medicine, Ramathibodi Hospital, Mahidol University, Bangkok, Thailand

Suwimol Prusmetikul

You can also search for this author in PubMed   Google Scholar

Contributions

RJ, SP and SW conceived the study. RJ carried out the search. RJ, SP and SW reviewed and appraised articles. RJ, SP and SW extracted data and synthesized results from articles. RJ, SP and SW prepared the original draft of the manuscript. RJ and SP prepared Figs. 1 and 2. All authors reviewed and edited the manuscript and agreed to the final version.

Corresponding author

Correspondence to Rebecca L. Jones .

Ethics declarations

Ethics approval and consent to participate.

Not required for this scoping review.

Consent for publication

Not applicable.

Competing interests

The authors declare no competing interests.

Additional information

Publisher’s note.

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Electronic supplementary material

Below is the link to the electronic supplementary material.

Supplementary Material 1

Supplementary material 2, rights and permissions.

Open Access This article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article’s Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article’s Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/ . The Creative Commons Public Domain Dedication waiver ( http://creativecommons.org/publicdomain/zero/1.0/ ) applies to the data made available in this article, unless otherwise stated in a credit line to the data.

Reprints and permissions

About this article

Cite this article.

Jones, R.L., Prusmetikul, S. & Whitehorn, S. Differential attainment in assessment of postgraduate surgical trainees: a scoping review. BMC Med Educ 24 , 597 (2024). https://doi.org/10.1186/s12909-024-05580-2

Download citation

Received : 27 February 2024

Accepted : 20 May 2024

Published : 30 May 2024

DOI : https://doi.org/10.1186/s12909-024-05580-2

Share this article

Anyone you share the following link with will be able to read this content:

Sorry, a shareable link is not currently available for this article.

Provided by the Springer Nature SharedIt content-sharing initiative

• Differential attainment
• Postgraduate

BMC Medical Education

ISSN: 1472-6920

• Submission enquiries: [email protected]
• General enquiries: [email protected]