SRS02 - From disparity to action: confronting differential attainment in surgery

Abstract Background Differential attainment (DA) describes persistent disparities in training outcomes across demographic groups, disproportionately affecting women, ethnic minority, and socioeconomically disadvantaged surgical trainees. Although widely recognised, the mechanism underpinning DA and the effectiveness of proposed solutions remain poorly synthesised. Methods A systematic review was conducted according to PRISMA guidelines (OSF registration: RC54V). MEDLIN, Embase and Scopus (2004–2024) were searched for studies analysing causes or interventions relating to DA in higher surgical training. Eligible studies included quantitative, qualitative, and mixed methods designs. Data were extracted in duplicate and quality appraised using CASP, Newcastle-Ottawa, or MMAT tools. A thematic synthesis categorised contributory factors and interventions at individual, institutional, and systemic levels. Results Forty-three studies met inclusion criteria (33 quantitative, 6 qualitative, 4 mixed methods). Spanning North America, UK, Australasia, Africa, and South Africa. Five recurring themes contributed to DA: gender and ethnic disparities, burnout, financial barriers, poor work-life integration, and harassment. Proposed interventions included structured mentorship, financial support, competency-based assessment, and anti-harassment policies. However, few were rigorously evaluated, co-designed with affected trainees, or demonstrated measurable reductions in DA. Entrenched systemic bias, particularly in subjective assessments and unequal access to mentorship and operative opportunities, remained pervasive. Conclusions DA in surgical training reflects structural inequalities rather than differences in ability. Despite growing awareness, interventions remain piecemeal and unevaluated. Urgent priorities include co-designed, evidence-based strategies and robust evaluation frameworks to embed equity in surgical education. This review provides actionable insights for surgical educators, training bodies, and policymakers.