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Differential attainment exists in all professions and is a manifestation of systemic factors creating an unequal environment where individual careers and aspirations may be thwarted. Although this inequality which affects some groups of students unfairly, has been recognised over the last 2 decades, it remains a significant issue. This scoping review explores the causes and contributors in relation to undergraduate medical education. Using thematic analysis, the authors present the case for tackling the disparity in education and training. There are evidence-based solutions for individuals, organisations and at a societal level. The recommendations from this review will be discussed and debated in the series of workshops, as part of the ‘Bridging the Gap’ series from the Alliance for Tackling Inequalities in Health, chaired by the British Association of Physicians of Indian origin. The output of the consensus-building workshops and thematic synthesis with the accompanying qualitative research will be presented in the final report due in 2021.

AimsDifferential attainment (DA) amongst Black and Minority Ethnic (BAME) medical students and postgraduate trainees including Psychiatry trainees has been extensively documented in medical education, with non-white medical students being 2.5 times more likely to fail high-stake examinations compared to their White counterparts. The Equality Act 2010 places a responsibility on public bodies such as Royal Colleges to address discrimination in training and assessment. Understanding DA in undergraduate medical education can help understand DA in the postgraduate setting. Consequently, this systematic review aims to detect the processes that enable and impede DA in UK undergraduate medical education.MethodSeven online databases including PubMed, Scopus, PyschInfo, and ERIC were searched. A formal grey literature search was also conducted. Inclusion criteria comprised studies dated from January 1995 to present and included UK undergraduate medical students. We present the preliminary findings from 13 papers, analysed to create a conceptual framework for a further mixed methods analysis. The studies were critically appraised for methodological quality.ResultFive key themes emerged from the preliminary analysis of 13 papers. BAME students experienced:Being ‘divergent’: Not feeling part of the current organisational learning milieuLack of social capital: Difficulty in being absorbed into existing ‘networks’ of relationships in a manner that is ‘approachable’ and not ‘intimidating’Continuum of discrimination: ‘Indirect’ impact of subtle communication processes in the learning environment undermining individual ‘belief’ in own performanceInstitutional discriminatory factors: Culture, rules, norms, and behavioural routines of educators that lead to differential outcomes for learnersLack of external support: Relative lack of interventions tackling DA.ConclusionThe key finding of this review is that British BAME undergraduate medical students experience discriminatory behaviours early in medical schools that impact on personal, educational, and professional outcomes. These factors may need to be borne in mind by postgraduate training organisations such as the Royal College of Psychiatrists as they commence the challenging task of addressing DA.