Intended for healthcare professionals


Manchester tackles failure rate of Asian students

BMJ 1995; 310 doi: (Published 28 January 1995) Cite this as: BMJ 1995;310:209

The University of Manchester Medical School admitted last month that male medical students with Asian surnames are more likely to fail their final clinical examinations than other students. Professor Stephen Tomlinson, dean of the school, said that 10 students out of 230 failed in 1994—all were male and had Asian surnames. These students were found to have failed their clinical but not their written exmainations. About a quarter of medical students at Manchester are from ethnic minorities, and most of these are Asian.

“It became clear during the summer of 1994 when these medical students failed that there was a problem,” said Professor Tomlinson. “We immediately set up a study to look at the overall performance of people with Anglo-Saxon names compared with people with names from ethnic minority groups. The numbers are small and it's difficult to separate them out, but our conclusion is that most of the students who failed would have been born in this country, although we don't know this for a fact because we have not asked where they were born.”

Aneez Esmail, a senior lecturer in general practice at Manchester University who has done research into ethnic minority issues, was a member of the working party set up to study the problem. “We used names as a proxy for ethnicity,” he said. “We found a significant statistical association between men with Asian names and failing clinical exams. We did not find the association in written exams. These were not substandard students. They were accepted to Manchester University on the basis of the same A level criteria as everyone else. If anything they are likely to have been above average.”

The working party has come up with recommendations that the medical school has agreed to adopt. New students will complete an ethnicity form on entering medical school and this will be used to monitor their performance. “We want to do a prospective study to follow this problem,” said Professor Roger Green, dean of medical undergraduate studies at the school.

“We are also introducing more structured exams that use more objective criteria to mark students. They will help to get rid of individual examiner bias. It's easier to identify what the problems are if examiners have to mark the history and examination in a structured way—for example, whether the candidate felt a patient's spleen or not.”

The medical school will also monitor the ethnicity of its examiners and put them through a training course that will deal with sex and ethnic issues. “We haven't diagnosed the problem yet,” said Professor Green. “In clinical finals there is a complicated interaction between the patient and student, the student and examiner, and even the patient and the examiner.”

In future the medical school will be looking at the ethnicity of patients who volunteer to participate in the clinical finals examinations. “In central Manchester about 10% of the population is Afro-Caribbean and 10% is Asian—we will be looking at the proportions that volunteer to take part in clinical finals,” said Professor Tomlinson.

“I would expect that all my fellow deans could ask the same questions as we have. This can't be a problem unique to Manchester, and it isn't unique to medicine. Whenever there is a one to one situation between an examiner and candidate you need to ask if people from ethnic minorities do less well. This issue goes across the whole of higher education whether it is in art, history, or languages.”

Students at Manchester who fail any part of their clinical finals are given one to one teaching and counselling. Professor Tomlinson said that over the past five years only two students who failed finals did not graduate with a medical degree. One had an Asian name and one had an Anglo-Saxon name.

Manchester's public approach to the problem is applauded by Dr Esmail. “I'm impressed that as soon as the problem became known there was a decision to do something about it. I have a lot of respect for the way that they took this seriously in Manchester.”

The University of Leicester Medical School has just over 100 medical students a year and about a quarter are from ethnic minority groups. Professor Frank Harris, dean of the medical school, said that in the past three years no British students with ethnic minority surnames had failed their final examinations.

“We do not ask students to make an ethnic declaration but we do keep an eye on what is going on because this is a very sensitive issue,” he said.

“Most students will fail finals on their clinical exams because written exams cannot compensate for clinical competence and the British system is biased towards clinical competence. In our finals students should see two examiners, and if they are going to fail then they should see the external examiner. If any discrimination is going on somewhere it must be something unconcsious—there can't be collusion.”—LUISA DILLNER, BMJ

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