This discussion paper has been prepared for the expert roundtable exploring the ‘Differential Attainment in PG Medical Education and Training’ planned for 17 September 2020. This will be the first engagement exercise launching the 2020 Thematic series on Tackling differential attainment in Healthcare professions, bringing together an interdisciplinary Alliance on equality in healthcare professions. This paper presents a preliminary outline of the current evidence on differential attainment in high stakes postgraduate summative assessment, explores its impact, deliberates on known causes, and discusses a number of potential solutions. This paper is written with a view to present the case for tackling DA in PG summative assessments and will be accompanied by a prioritised selection of ‘focused questions and solutions’ to be discussed at the roundtable with subject experts. This paper and roundtable will form part of, and contribute to the thematic synthesis in the section on ‘Assessment - formative and summative’. Therefore, as described in the ‘protocol’, will be followed by a focused systematic review, engagement with priority setting partnerships (via questionnaires, focus groups, and workshops) and culminate in an expert consensus. The final outcome will be presented as-synthesized recommendations, solutions, policy enablers, and areas for further research.