Equity in basic medical education accreditation: A scoping review

Introduction: Accreditation standards ensure quality in undergraduate or basic medical education (BME). Equity is often described alongside diversity and inclusion but its roles in the development and implementation of accreditation standards remain unclear. In this scoping review, we explored how the term "equity" is portrayed in the BME accreditation literature. Methodology: We performed a scoping review following the Joanna Briggs Institute protocol using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses-Scoping Review (PRISMA-ScR) extension. Systematic search was conducted across five databases and grey literature sources from their inception until May 2024. We included studies that explicitly or implicitly discussed the concept of equity in relation to the BME accreditation process. Inductive thematic analysis of the selected literature was conducted based on the approach of Braun and Clarke. Results: Among 1105 records, 15 met the inclusion criteria. None of the selected studies explicitly used the term "equity." All 15 records discussed the "contextual" adaptation of accreditation standards and were labeled as discussing "equity" implicitly. These implicit discussions revealed three recurring domains: (1) equity at the interregional level, highlighting Global North and South disparities and the risks of Western hegemony; (2) equity at the intraregional level, reflecting inequities between well-resourced and under-resourced institutions; and (3) equity at the surveyor level, emphasizing the influence of the evaluator's background and training. Discussion: Equity is a fundamental but often vaguely defined concept in the context of BME accreditation processes. We propose a three-level framework for describing equity in this context to assist regulators, accrediting organizations, and policy makers in the development and implementation of accreditation processes.