Academic performance of ethnic minorities in medical schoolBMJ 2008; 337 doi: https://doi.org/10.1136/bmj.a1094 (Published 19 August 2008) Cite this as: BMJ 2008;337:a1094
All rapid responses
I read with interest the editorial written by Phyllis Carr and
Jonathon Woodson from Boston, USA suggesting that we need to find better
ways of evaluating the motivations of candidates applying to medical
schools . Their suggestion is based on the findings from two studies
done on medical students from ethnic minorities [2, 3].
Medical schools prefer students with genuine, intrinsic interest in
medicine or altruistic care directed motives above students who aim to
gain personal status or high income. Those selecting have a duty to ensure
that selection is fair and a legal obligation under the Race Relations Act
1976 and the Sex Discrimination Act 1975 to ensure that selection does not
discriminate according to ethnic origin or sex. It is a well known fact
that institutional discrimination can exist where the allegedly objective
practices, protocols, and procedures of an organisation result, albeit
unintentionally, in deleterious outcomes for certain groups. In other
words, discrimination can be subtle and insidious too. It does not have to
be explicit, overt and readily identifiable . People from ethnic
minority groups applying to medical school are shown to be at disadvantage
, principally because ethnic origin is assessed from a candidate's
surname . There is sufficient evidence to suggest that doctors from the
ethnic minority are at disadvantage at all stages of their career [7, 8,9].
Despite the proven discrimination medical students from ethnic
minority pass all the criteria pose by the authorities responsible for
medical schools admission. Their admissions in medical schools prove their
motivation and self determination. Whether that motivation is derived by
the intrinsic or extrinsic factors is debateable. Medical students from
the ethnic minorities are conscientious, hardworking and bright in terms
of book learning . They might be weaker in communicating with patients
and teachers. My fifteen years personal experience of teaching medical
students in UK has shown that medical students of ethnic minority origin
who have been born and brought up in UK are as good in communication as
their white British colleagues. Instruments, if any available, use to
scrutinize their motivation, if introduced, will not be seen without
suspicion. Around 6% of the United Kingdom population are Asian, but they
constitute 28% of medical school applicants and 21.7% of those receiving
offers of a medical school place . This percentage will rise in light
of the government’s widening participation initiative . The cause of
the difference in performance of medical students of different ethnic
origin is not very clear. Non-UK ethnic minority students have shown
better performance than UK -white student in some aspects of assessment
. At postgraduate level, the study on the effects of ethnicity and
gender on pass rates in UK medical graduates sitting the Membership of the
Royal Colleges of Physicians in the United Kingdom [MRCP(UK)] Examination
has shown that differences are multifactorial. . It would be
appreciated if authors would have provided any evidence to prove that
doctors, the final product of a medical school, from ethnic minorities are
underachievers, taking the ethnic discrimination out of the equation.
The issue of ensuring cultural competence of medical graduate to
increase the academic performance of ethnic minorities is an interesting
concept posed by the authors. I fail to understand the basis of
correlation of cultural competency and academic performance and also the
need and process of assessment of “Cultural Competency” in medical
Around 7.7 million people in England (15 %) of the population) belong
to ethnic minority populations, defined as all ethnic groups other than
white British. In 46 out of 354 English local authorities, more than 20%
of the population is non white British. In some areas ethnic minorities
comprise more than 50% of the local population. Due to recent inward
migration from Eastern Europe, the population of UK has become more
diverse and changing . Study in US has shown that the ethnically
diverse medical school population is associated with outcomes consistent
with the goal of preparing students to meet the needs of a diverse
population . It would be very interesting to assess the academic
performance of white British doctors and medical students in those areas
of UK where doctors rely totally on the interpreters to get the history
from the patients from ethnic minority. Also to compare the academic
performance of medical students from ethnic minority group working in
predominant white community.
Medical students in general receive their feedback about their
communication skills with patients and their colleagues on regular basis.
They are taught and assessed on their ability of “professional
interaction” with patients and colleagues. As authors suggest providing
feedback on the quality of their “social interaction” would certainly
require some training of that particular skill against which they would
receive a feedback.
The social and cultural practices are geographically variable. The
social and cultural norms of one part of a country differ from other, not
to mention about differences between the countries. I could not find any
significant scientific evidence to prove that it would enhance “academic
performance” of a doctor.
Extrapolating authors suggestion to medical practice, a medical
council or a licensing authority might have to consider to introduce a
local “Test of Social and Cultural Competence” to judge a doctors academic
performance in a local setting.
Since 1975 General Medical Council has tested about 140,000
International Medical Gaduates (IMG) for their linguistic and professional
competency (PLAB). Most of these graduates are non-white and belong to
ethnic minority group. Despite passing through that vigorous test of
competency, IMGs are over represented throughout all stages of GMC’s
fitness to practice. These facts are the cause of concern and GMC’s
Equality and Diversity Research Forum is already looking at the issue (GMC
today: September 2008).
Medical schools in US have been criticised of doing poor job of
increasing the diversity of their students. Issues of complacency, poor
leadership and a distinct lack of political will on the part of government
have all been addressed . Recently, in UK significant efforts have
been made to minimize the issue of discrimination and promote diversity at
all levels including admission in medical schools, postgraduate training
and medical practice in National Health Service.
I urge all the concerned authorities that serious consideration
should be given to justify before imposing any further test on the medical
student at the admission stage in the name of academic performance.
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Competing interests: No competing interests