Learning in practice

Effect of ethnicity on performance in a final objective structured clinical examination: qualitative and quantitative study

Val Wass, senior lecturer in general practice, ^a Celia Roberts, senior research fellow, ^b Ron Hoogenboom, research assistant, ^c Roger Jones, Wolfson professor of general practice, ^a Cees Van der Vleuten, professor of education. ^c

^a Department of General Practice and Primary Care, Guy's, King's, and St Thomas's School of Medicine, London SE11 6SP, ^b Department of Education and Professional Studies, King's College, London SE11 6SP, ^c Department of Educational Development and Research, University of Maastricht, Maastricht, Netherlands

Correspondence to: V Wass valerie.wass{at}kcl.ac.uk

Objective: To assess the effect of ethnicity on student performance in stations assessing communication skills within an objective structured clinical examination.
Design: Quantitative and qualitative study.
Setting: A final UK clinical examination consisting of a two day objective structured clinical examination with 22 stations.
Participants: 82 students from ethnic minorities and 97 white students.
Main outcome measures: Mean scores for stations (quantitative) and observations made using discourse analysis on selected communication stations (qualitative).
Results: Mean performance of students from ethnic minorities was significantly lower than that of white students for stations assessing communication skills on days 1 (67.0% (SD 6.8%) and 72.3% (7.6%); P=0.001) and 2 (65.2% (6.6%) and 69.5% (6.3%); P=0.003). No examples of overt discrimination were found in 309 video recordings. Transcriptions showed subtle differences in communication styles in some students from ethnic minorities who performed poorly. Examiners' assumptions about what is good communication may have contributed to differences in grading.
Conclusions: There was no evidence of explicit discrimination between students from ethnic minorities and white students in the objective structured clinical examination. A small group of male students from ethnic minorities used particularly poorly rated communicative styles, and some subtle problems in assessing communication skills may have introduced bias. Tests need to reflect issues of diversity to ensure that students from ethnic minorities are not disadvantaged.

What is already known on this topic UK medical schools are concerned that students from ethnic minorities may perform less well than white students in examinations It is important to understand whether our examination system disadvantages them What this study adds Mean performance of students from ethnic minorities was significantly lower than that of white students in a final year objective structured clinical examination Two possible reasons for the difference were poor communicative performance of a small group of male students from ethnic minorities and examiners' use of a textbook patient centred notion of good communication Issues of diversity in test construction and implementation must be addressed to ensure that students from ethnic minorities are not disadvantaged