Academic performance of ethnic minorities in medical school

BMJ 2008; 337 doi: https://doi.org/10.1136/bmj.a1094 (Published 19 August 2008) Cite this as: BMJ 2008;337:a1094
  1. Phyllis Carr, associate dean for student affairs,
  2. Jonathon Woodson, associate dean for diversity
  1. 1Boston University School of Medicine, Boston, MA 02493, USA
  1. plcarr{at}bu.edu

    May be adversely affected by negative stereotyping

    Increasing the number of doctors in the workforce who come from minority groups has been proposed as a way to tackle the health disparities of minority populations. Several themes have arisen regarding the education of such doctors, including low numbers of students from ethnic minorities applying for medical school, worse prior preparation in the sciences and humanities, and underachievement in their medical education.1

    The qualitative study by Woolf and colleagues (doi: 10.1136/bmj.a1220) provides important insights into one aspect that affects clinical education in the United Kingdom—how ethnic stereotyping can add to a downward trend in performance.2 This reflects findings on how race affects the evaluation of African-American students in the United States, including the nature of the student-teacher interaction and the biases that may affect the evaluation of students and the educational process.1 Differences in the expectations and treatment of students that stem from pervasive negative stereotypes adversely affect their learning and self confidence. This seems to be particularly so during the clinical parts of a medical education, when differences in cultural formality, linguistic differences in accents, and communication styles can affect not only the interaction between teacher and student, but the ability of the student to connect with the patient and obtain a comprehensive medical history. When students from a minority group are perceived by faculty to be shy, quiet, reserved, not engaged in their education, and following parental motivation rather than an innate passion for medicine, their ability to excel is greatly reduced.

    Woolf and colleagues suggest that getting to know the individual student on a personal level is an effective means to tackle “stereotype threat.” For a profession such as medicine, we should not only teach students, but also mentor them. Studies in business have shown that people from minority groups who received mentoring on instructional development skills reached a plateau in middle management, whereas those whose mentors taught them broader developmental skills—which tackled negative stereotypes, public scrutiny, difficulty with role modelling, and peer resentment—achieved higher executive positions.3

    Knowing students as individuals is important in any form of education, but particularly in medicine, where collegial interactions and those with patients are so key to the quality of care. This can also help in tackling the “hidden curriculum”—the extracurricular influences that a medical student is exposed to in medical schools—which often negates the professionalism and values that we need to instill in our students.4 Similarly, we need to be aware of the “mental models” that we harbour—the picture that we spontaneously recall when approached by a person of a particular ethnicity—so that we can reconsider how we develop awareness of the attitudes and perceptions that influence our thoughts and interactions with people from minority groups.5 We live in a world of increasing diversity, and we need to understand and appreciate differences in race, ethnicity, and culture.

    Woolf and colleagues also report sex differences that reflect another dimension of our ability to provide excellence in medical education. In the medical school where their study took place, women were largely aggregated in general practice (five women), whereas men were more likely to be consultant physicians (10 men, two women), or consultant surgeons (five men, one woman). Why aren’t the numbers of men and women in each specialty more equal? The disparity reflects the glass ceiling affecting women and their advancement in academic medicine, including specialties in which women are under-represented, such as surgery.

    When questioned about the lack of engagement of students, female doctors questioned their teaching ability and attempted to find out the reason for the lack of engagement and tried to get to know their students. Male surgeons indicated that they decreased their teaching or made it more difficult for students who were less engaged. Unfortunately the authors did not comment further on the potential reasons behind these differences between the sexes. Ethnic and racial differences are important, but gender differences are equally pervasive.

    The study provides important new insights and raises other questions about the medical curriculum. Should students be given the opportunity to develop and receive feedback on the quality of their social interactions? Should culturally determined patterns of communication be altered to optimise interaction with patients or teachers? Both of these questions can be dealt with by ensuring the cultural competence of our medical graduates through more formal curriculums and evaluation of these important skills. We also need better ways to evaluate the motivations of candidates applying to medical schools.


    Cite this as: BMJ 2008;337:a1094



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