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Differential attainment in surgical and dental exams


In March 2021 we published the findings of the Kennedy Review, which looked into the diversity of the leadership of the surgical profession and of the College. In September 2021 we published our Diversity, Equity and Inclusion Action Plan which addresses the 16 recommendations made in the review.

It is widely acknowledged that differential attainment in surgical exams exists. The Kennedy Review brought to light that we needed to be doing much more to understand and address this, recommending that the College prioritises a study and dedicated plan to close the gaps.

What has been done so far?

A considerable amount of research into differential attainment has already been undertaken by the four Surgical Royal Colleges of the UK and in Ireland through the Intercollegiate Committee for Basic Surgical Examinations (ICBSE) research team. The team has published extensively on differential attainment in relation to both protected characteristics and a range of environmental factors.

This output provides an excellent understanding of the nature and scale of differential attainment within surgical exams, particularly within the MRCS.

In relation to protected characteristics, the most recent ICBSE paper to be published showed the following:

  • Male candidates were more likely to pass at Part A and Part B than female candidates
  • White candidates were more likely to pass than candidates from other ethnic groups, at Part A and Part B, with Black or Black British candidates least likely to pass.
  • Candidates under the age of 29 at graduation were more likely to pass at Part Aand Part B than candidates over the age of 29

Overall, the ICBSE study identified ‘significant differences in MRCS performance between sociodemographic groups, likely to represent the accumulation of privilege and disadvantage experienced by individuals throughout their education and training.’

This research highlights the Kennedy Review’s key position that differential attainment is not a function of learner deficit; rather, examination outcomes shine a light on broad inequities existing elsewhere in the learner environment and beyond.

What we're doing as a College

The ICBSE research has done a huge amount to enable us to understand the nature of the attainment gap in surgical examinations. Our aim as a College is to implement targeted interventions in the training environment that seek to close this gap.

In order to do this, our first action will be to understand more from our candidates about their experience of preparing for and taking examinations with us, and how that experience could have been improved.

From these insights, we will be able to start designing the interventions that should be most effective in addressing the issues candidates face during their surgical training, and specifically when preparing for and sitting examinations with us.

Our initial work will focus on our candidates’ experience of the MRCS, but it will be key that we continue to look at learning from this work and apply it to other surgical and dental examinations.

How we’ll measure our impact

It will be important that any interventions are externally reviewed and measured, and that our overall success in closing the attainment gap is subject to external scrutiny and review.

It is equally important that these interventions are not ‘one off’ initiatives, but are designed to be integrated into the College’s business-as-usual activities, informed by our culture and values.

Next steps

We are commissioning a survey of RCS England’s MRCS candidates to learn more about their experiences of taking the Part A and Part B, and to help us plan our initial interventions. We hope to share the results from this survey in early Autumn 2022, along with our action plan for our proposed initiatives.

How to get involved

We want to open up this work and be inclusive in delivering it – but that takes planning to make sure that we co-ordinate effort and make the most of your valuable time. At this stage, please email us to express an interest and we will be in touch to explain how you can get involved.

We will continue to update this page with new developments as we have them. Please keep an eye out for these in our member newsletter and social channels.

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