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

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      BMJ : British Medical Journal
      BMJ Publishing Group Ltd.

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          Abstract

          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.

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          Most cited references28

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          Stereotype threat and the intellectual test performance of African Americans.

          Stereotype threat is being at risk of confirming, as self-characteristic, a negative stereotype about one's group. Studies 1 and 2 varied the stereotype vulnerability of Black participants taking a difficult verbal test by varying whether or not their performance was ostensibly diagnostic of ability, and thus, whether or not they were at risk of fulfilling the racial stereotype about their intellectual ability. Reflecting the pressure of this vulnerability, Blacks underperformed in relation to Whites in the ability-diagnostic condition but not in the nondiagnostic condition (with Scholastic Aptitude Tests controlled). Study 3 validated that ability-diagnosticity cognitively activated the racial stereotype in these participants and motivated them not to conform to it, or to be judged by it. Study 4 showed that mere salience of the stereotype could impair Blacks' performance even when the test was not ability diagnostic. The role of stereotype vulnerability in the standardized test performance of ability-stigmatized groups is discussed.
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            • Article: not found

            Factors associated with success in medical school: systematic review of the literature.

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              • Article: not found

              Ethnicity as a variable in epidemiological research.

              Ethnicity is used increasingly as a key variable to describe health data, and ethnic monitoring in the NHS will further stimulate this trend. We identify four fundamental problems with ethnicity in this type of research: the difficulties of measurement, the heterogeneity of the populations being studied, lack of clarity about the research purpose of the research, and ethnocentricity affecting the interpretation and use of data. Ethnicity needs to be used carefully to be a useful tool for health research. We make nine recommendations for future practice, one of which is that ethnicity and race should be recognised and treated as distinct concepts.
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                Author and article information

                Contributors
                Role: lecturer in medical education
                Role: senior lecturer in health informatics
                Role: professor of psychology and medical education
                Journal
                BMJ
                bmj
                BMJ : British Medical Journal
                BMJ Publishing Group Ltd.
                0959-8138
                1468-5833
                2011
                2011
                08 March 2011
                : 342
                : d901
                Affiliations
                [1 ]Academic Centre for Medical Education, UCL Division of Medical Education, London N19 5LW, UK
                [2 ]Centre for Health Informatics and Multiprofessional Education, UCL Division of Population Health, London N19 5LW
                Author notes
                Correspondence to: K Woolf k.woolf@ 123456medsch.ucl.ac.uk
                Article
                wook785964
                10.1136/bmj.d901
                3050989
                21385802
                d345627e-4daa-4f76-8620-728bc8bdfee6
                © Woolf et al 2011

                This is an open-access article distributed under the terms of the Creative Commons Attribution Non-commercial License, which permits use, distribution, and reproduction in any medium, provided the original work is properly cited, the use is non commercial and is otherwise in compliance with the license. See: http://creativecommons.org/licenses/by-nc/2.0/ and http://creativecommons.org/licenses/by-nc/2.0/legalcode.

                History
                : 29 December 2010
                Categories
                Research
                Ethnic Studies
                Internet
                Undergraduate
                Medical Humanities

                Medicine
                Medicine

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