Affirmative action programmes in postgraduate medical and surgical training—A narrative review

Abstract

Objective This review aims to identify and summarise the literature pertaining to the implementation of affirmative action programmes (AAP) for selection of ethnic minorities and Indigenous peoples into selective specialist medical and surgical training programmes. Methods A systematic literature search was conducted to identify relevant studies reporting on the background, implementation and results of AAP for ethnic minorities and Indigenous peoples into medical and surgical training. MEDLINE, EMBASE, PubMed, Scopus and Google Scholar databases were queried from inception through to 1 February 2020. All included studies were subjected to inductive thematic analysis in order to systematically collate study findings. Articles were read through several times in an iterative manner to allow the identification of themes across the included studies. The themes were cross‐compared among the authors to establish their interconnectedness. Results Forty‐five articles described AAP pertaining to ethnic minorities in the United States of America (African‐Americans and Hispanic Americans), women and ethnic minorities, Indigenous peoples (New Zealand Māori) and people with low socio‐economic status. Four themes were identified. These included the need for social responsiveness in clinical training organisations, justification and criticism of AAP, how clinical training agencies should participate in AAP and what constitutes an effective AAP for specialist medical and surgical training. Conclusions Affirmative action programmes have been effective at increasing numbers of ethnic minority medical school graduates but have not been used for specialist medical or surgical training selection. AAP achieve the best results when they are associated with a comprehensive programme of candidate preparation, support and mentorship beginning prior to application, and support and mentorship extending through training and subsequently into the post‐training period as an independent professional. The overall aim of any AAP in medical or surgical training must be graduation of significant numbers of minority and Indigenous trainees into successful practice with appointment to faculty member and leadership positions.

Social inclusivity – Medical education’s next hurdle

“…Instead, Koea et al 1 argue we consider WP and AAP as a pathway, rather than a single step process. A path that starts before application and continues throughout undergraduate and postgraduate medical education 1 .…”

“…Medicine has long been considered a profession of the select few with institutions favouring candidates from selective backgrounds, creating a medical workforce that lacks diversity and does not reflect the population it serves 1 . In order to address this imbalance and level the playing field, many institutions have adopted widening participation (WP) and affirmative action programs (AAP) 1‐3 . These programs often utilise a contextually based selection process or offer an extended undergraduate degree programme 2,3 .…”

“…These programs often utilise a contextually based selection process or offer an extended undergraduate degree programme 2,3 . The primary aim of which is to encourage students from under‐represented groups including those from black and minority ethnic (BME) groups, those from lower socio‐economic groups and those who are the first‐in‐family to attend university, to consider medicine as a career 1,4 …”

“…A recent review by Koea et al 1 found that AAP has been effective in increasing the numbers of ethnic minority and Indigenous medical students. In the United Kingdom (UK), WP programs report similar outcomes.…”

“…Currently, within the literature, the outcome of these programs is commonly reported as the percentage increase of new medical students each year from under‐represented backgrounds 2,5,10 . Koea et al 1 highlight the problem with measuring effectiveness in this way; it encourages the perception that inequalities in education and selection processes are solely an issue at the point of entry to medical school.…”