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Ethnicity and academic performance in UK trained doctors and medical students: systematic review and meta-analysis

BMJ 2011; 342 doi: (Published 08 March 2011) Cite this as: BMJ 2011;342:d901
  1. Katherine Woolf, lecturer in medical education1,
  2. Henry W W Potts, senior lecturer in health informatics2,
  3. I C McManus, professor of psychology and medical education1
  1. 1Academic Centre for Medical Education, UCL Division of Medical Education, London N19 5LW, UK
  2. 2Centre for Health Informatics and Multiprofessional Education, UCL Division of Population Health, London N19 5LW
  1. Correspondence to: K Woolf k.woolf{at}
  • Accepted 29 December 2010


Objective To determine whether the ethnicity of UK trained doctors and medical students is related to their academic performance.

Design Systematic review and meta-analysis.

Data sources Online databases PubMed, Scopus, and ERIC; Google and Google Scholar; personal knowledge; backwards and forwards citations; specific searches of medical education journals and medical education conference abstracts.

Study selection The included quantitative reports measured the performance of medical students or UK trained doctors from different ethnic groups in undergraduate or postgraduate assessments. Exclusions were non-UK assessments, only non-UK trained candidates, only self reported assessment data, only dropouts or another non-academic variable, obvious sampling bias, or insufficient details of ethnicity or outcomes.

Results 23 reports comparing the academic performance of medical students and doctors from different ethnic groups were included. Meta-analyses of effects from 22 reports (n=23 742) indicated candidates of “non-white” ethnicity underperformed compared with white candidates (Cohen’s d=−0.42, 95% confidence interval −0.50 to −0.34; P<0.001). Effects in the same direction and of similar magnitude were found in meta-analyses of undergraduate assessments only, postgraduate assessments only, machine marked written assessments only, practical clinical assessments only, assessments with pass/fail outcomes only, assessments with continuous outcomes only, and in a meta-analysis of white v Asian candidates only. Heterogeneity was present in all meta-analyses.

Conclusion Ethnic differences in academic performance are widespread across different medical schools, different types of exam, and in undergraduates and postgraduates. They have persisted for many years and cannot be dismissed as atypical or local problems. We need to recognise this as an issue that probably affects all of UK medical and higher education. More detailed information to track the problem as well as further research into its causes is required. Such actions are necessary to ensure a fair and just method of training and of assessing current and future doctors.


  • We thank Mark Carroll, David James, Sue Kilminster, Trudie Roberts, and Andy Lumb for sharing their raw and unpublished data with us.

  • Contributors: ICM conceived the idea for the study, which was further developed with KW and HWWP. KW and HWWP decided on inclusion and exclusion criteria. KW and ICM searched for reports and extracted data. All authors double extracted data and contributed to the statistical analysis and interpretation of results. KW prepared the first draft of the paper, and all authors contributed to subsequent drafts and agreed on the final report. All contributors had full access to all of the data (including statistical reports and tables) in the study and can take responsibility for the integrity of the data and the accuracy of the data analysis. KW is guarantor.

  • Funding: This research received no specific grant from any funding agency in the public, commercial, or not-for-profit sectors.

  • Competing interests: All authors have completed the Unified Competing Interest form at (available on request from the corresponding author) and declare: no support from any organisation for the submitted work; no financial relationships with any organisations that might have an interest in the submitted work in the previous three years; no other relationships or activities that could appear to have influenced the submitted work.

  • Ethical approval: The study was covered by the exemptions of the UCL research ethics committee Consent from participants was not obtained but the presented data are anonymised and risk of identification is low.

  • Data sharing: Datasets are available from the corresponding author at k.woolf{at}

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