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It’s about more than end point assessment: a realist exploration of differential attainment in health professions education

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Gabrielle Finn1
1 ASME



Differential attainment (DA) is the unexplained variation in attainment between groups when split by a number of protected characteristics, including age, gender and race. Like many institutions, the University of Manchester has awarding gaps for Black, Asian, and Disabled students. Institutions are under pressure to reduce differential attainment, but to date there are no agreed causes of these variations. 

We conducted a realist evaluation to explore the contexts, mechanisms, and outcomes (CMOs) associated with DA within the Faculty of Biology, Medicine, and Health at the University of Manchester. Over150 realist interviews have been conducted with healthcare students, and University stakeholders. 


Results:
We will highlight our programme theory as to the causes of, and solutions to, differential attainment - with a particular lens on assessment. Our data highlight the staggering impact of the lack of inclusive assessment across the student journey. Findings demonstrate how bias can also perpetuate discriminatory patterns that contribute to health inequalities. 


Discussion: 
We often look at end point assessment as the issue when considering DA, yet the reality from our data is that it is also a consequence of the daily discriminatory behaviours students face. These issues manifest in the culture, curriculum, and assessment resulting in a detrimental impact on student wellbeing, learning, and subsequent attainment. Educators exacerbate this problem due to their lack awareness that assessments are neither value neutral, nor culture free. 


Conclusion:
It is important to appreciate that with diverse cohorts, there are often cultural taboos preventing students from seeking help, especially concerning assessment. Assessors are often reluctant to make accommodations for learners, allowing the fear of students cheating or the notion of less robust assessments take over. 


Take home/implications:
Differential attainment is a complex issue but moves towards inclusive and socially just assessments go some way to levelling the playing field for students. 



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