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Mawdsley A, Magola-Makina E, Willis SC. Towards addressing the awarding gap-Using critical race theory to contextualise the role of intersectionality in Black pharmacy student attainment. MEDICAL EDUCATION 2024. [PMID: 38938192 DOI: 10.1111/medu.15460] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/29/2023] [Revised: 05/01/2024] [Accepted: 05/29/2024] [Indexed: 06/29/2024]
Abstract
INTRODUCTION The awarding gap between White and Black students in UK health curricula is well established. Critical race theory (CRT) is a lens to deconstruct pedagogic practice and consider the intersectionality of Black student lived experience to provide a realist critique of the phenomenon of Whiteness in higher education and the impact this has on Black attainment. Using one UK pharmacy programme as a case study, this paper aims to explore Black lived experience as a means of problematising and disrupting structural oppressions. METHODS Sixteen Black students from one UK pharmacy degree programme were purposively recruited to the study. Love and breakup letter methodology (LBM) was used to facilitate sharing experiences of intersectionality in relation to their undergraduate education, with data thematically analysed through the lens of CRT. RESULTS Two meta-themes (identity and inclusion; and cultural capital) and four subthemes (social capital; access; family expectations; and help-seeking) were identified. The intersectionality of Black students was articulated as not possessing the social capital and the 'language' to succeed within the White structures of the curriculum. The conflict of capital and the absence of Black culture gave rise to confined help-seeking behaviours. Whilst Black students experienced equality of access to the curriculum, an absence of rights to legitimate involvement (inclusion) worked to diminish participation in the curriculum. DISCUSSION This is the first study to consider the intersectionality of Black pharmacy students in relation to academic awarding gaps and has found that oppressive educational structures marginalise and other Black experience. Black students experience the curriculum as a place where their social and cultural capital is undervalued, and as a White space where they lack the artefacts to succeed, leading to peripheral participation and detachment. The approach used in this study can be adopted across medical and health education as a means to problematise racial inequality through the exemplar of White:Black awarding gaps.
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Affiliation(s)
- Andrew Mawdsley
- Division of Pharmacy and Optometry, University of Manchester, Manchester, UK
| | | | - Sarah C Willis
- Alliance Manchester Business School, University of Manchester, Manchester, UK
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Iyizoba-Ebozue Z, Fatimilehin A, Kayani M, Khan A, McMahon M, Stewart S, Croney C, Sritharan K, Khan M, Obeid M, Igwebike O, Batool R, A-Hakim R, Aghadiuno T, Ruparel V, O'Reilly K. Unveiling Disparities: Exploring Differential Attainment in Postgraduate Training Within Clinical Oncology. Clin Oncol (R Coll Radiol) 2024; 36:e119-e127. [PMID: 38582627 DOI: 10.1016/j.clon.2024.03.021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2023] [Revised: 03/06/2024] [Accepted: 03/15/2024] [Indexed: 04/08/2024]
Abstract
AIMS Differential attainment (DA) in post graduate medical training is a recognised challenge and refers to unexplained variation across groups when split by several protected characteristics. The Royal College of Radiology is committed to fostering diversity, inclusivity, and equality with the goal of narrowing existing gaps and improving training outcomes. MATERIALS AND METHODS This was a mixed methods study aiming to understand the causes of DA with view to helping the RCR develop strategies to address this. A cross-sectional survey was completed by 140 clinical oncology trainees in September 2022. Trainees and trainers (17 and 6 respectively) from across England, Scotland, Wales and Northern Ireland, took part in focus group and interviews from August to December 2022. Quantitative and qualitative data merged and interpreted. RESULT Results showed international medical graduates and trainees from ethnic minority backgrounds were more likely to encounter challenges. The qualitative findings were used to identify three themes through which these problems could be framed. The trainee as a "space invader," the hidden curriculum of clinical oncology training and the process of navigating and tacking the training journey. CONCLUSION Differential attainment is the product of a complex interplay between the trainee, trainer, and the training environment. Therefore, interventions must be tailored to different people and contexts. At a national level, the RCR can adopt general policies to promote this such as mentorship programmes, protected time for supervision and cultural competency training. Efficacy of proposed interventions for trial and their impact on DA should be evaluated to drive evidence-based changes.
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Affiliation(s)
- Z Iyizoba-Ebozue
- Department of Clinical Oncology, Leeds Cancer Centre, Leeds, UK.
| | - A Fatimilehin
- Department of Clinical Oncology, The Christie NHS Foundation Trust, Manchester, UK
| | - M Kayani
- Department of Clinical Oncology, Leeds Cancer Centre, Leeds, UK
| | - A Khan
- Department of Clinical Oncology, The Royal Marsden NHS Foundation Trust, London, UK
| | - M McMahon
- Department of Clinical Oncology, Northern Ireland Cancer Centre, Northern Ireland, UK
| | - S Stewart
- Department of Clinical Oncology, University College London Hospital, London, UK
| | - C Croney
- Department of Clinical Oncology, Northern Ireland Cancer Centre, Northern Ireland, UK
| | - K Sritharan
- Department of Clinical Oncology, University College London Hospital, London, UK
| | - M Khan
- Department of Clinical Oncology, Northern Ireland Cancer Centre, Northern Ireland, UK
| | - M Obeid
- Department of Clinical Oncology, The Christie NHS Foundation Trust, Manchester, UK
| | - O Igwebike
- Department of Clinical Oncology, Western Park Cancer Centre, Sheffield, UK
| | - R Batool
- Department of Clinical Oncology, The University Hospital Coventry, West midlands, UK
| | - R A-Hakim
- Department of Clinical Oncology, The Royal Marsden NHS Foundation Trust, London, UK
| | - T Aghadiuno
- Department of Clinical Oncology, Velindre Cancer Centre, Cardiff, Wales, UK
| | - V Ruparel
- Department of Clinical Oncology, Aberdeen Royal Infirmary, Aberdeen, Scotland UK
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Brown C, Khavandi S, Sebastian A, Badger K, Westacott R, Reed MWR, Gurnell M, Sam AH. The influence of candidates' race on examiners' ratings in standardised assessments of clinical practice. MEDICAL TEACHER 2024:1-6. [PMID: 38771961 DOI: 10.1080/0142159x.2024.2345266] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/03/2023] [Accepted: 04/16/2024] [Indexed: 05/23/2024]
Abstract
PURPOSE Delivering fair and reliable summative assessments in medical education assumes examiner decision making is devoid of bias. We investigated whether candidate racial appearances influenced examiner ratings in undergraduate clinical exams. METHODS We used an internet-based design. Examiners watched a randomised set of six videos of three different white candidates and three different non-white (Asian, black and Chinese) candidates taking a clinical history at either fail, borderline or pass grades. We compared the median and interquartile range (IQR) of the paired difference between scores for the white and non-white candidates at each performance grade and tested for statistical significance. RESULTS 160 Examiners participated. At the fail grade, the black and Chinese candidates scored lower than the white candidate, with median paired differences of -2.5 and -1 respectively (both p < 0.001). At the borderline grade, the black and Chinese candidates scored higher than the white candidate, with median paired differences of +2 and +3, respectively (both p < 0.001). At the passing grade, the Asian candidate scored lower than the white candidate (median paired difference -1, p < 0.001). CONCLUSION The racial appearance of candidates appeared to influence the scores awarded by examiners, but not in a uniform manner.
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Affiliation(s)
- Celia Brown
- Division of Health Sciences, Warwick Medical School, Coventry, UK
| | - Sarah Khavandi
- Imperial College School of Medicine, Imperial College London, London, UK
| | - Ann Sebastian
- Imperial College School of Medicine, Imperial College London, London, UK
| | - Kerry Badger
- Imperial College School of Medicine, Imperial College London, London, UK
| | - Rachel Westacott
- Birmingham Medical School, University of Birmingham, Birmingham, UK
| | - Malcolm W R Reed
- Brighton and Sussex Medical School, University of Sussex, Brighton, UK
| | - Mark Gurnell
- Wellcome-MRC Institute of Metabolic Science, University of Cambridge and NIHR Cambridge Biomedical Research Centre, Cambridge University Hospitals, Cambridge, UK
| | - Amir H Sam
- Imperial College School of Medicine, Imperial College London, London, UK
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Bull S, Terry R, Rice N, Carrieri D, Tarrant M, Curnow G. Social connections and social identity as a basis for learning and support: Experiences of medical students with minoritised and non-minoritised ethnic identities. MEDICAL EDUCATION 2024. [PMID: 38414290 DOI: 10.1111/medu.15367] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/21/2023] [Revised: 01/25/2024] [Accepted: 02/08/2024] [Indexed: 02/29/2024]
Abstract
BACKGROUND Social connections between medical students provide a key basis for learning and support. These connections, and associated social identity, may be patterned by ethnicity, and students often perform similarly academically to those they connect with. The mechanisms that underpin the formation of these connections and the role that they play are not fully understood. This study explored how medical students connect with each other, and the potential impact of this on their academic attainment and well-being, with a focus on students with minoritised ethnic identities. METHODS A mixed methods study combining (1) a survey to establish the number and strength of connections formed by Years 1 and 2 medical students with both minoritised and non-minoritised ethnicities and (2) semi-structured interviews to understand how connections were formed, whether this was shaped by ethnicity and the role of connections in supporting students with their learning and well-being. RESULTS One hundred fifty-one students (15.5% response rate) completed the survey. Students connected regularly with three to four peers with the goal of supporting learning and 71.9% of students reported a sense of social identification with this group. There was no statistical difference between ethnically minoritised and White students on either of these measures (t = 0.1, p = 0.92, χ2 = 2.9, p = 0.56). Interviews with 19 students found that social connections were shaped by perceptions of their self-identity and the need to find 'equilibrium' by forming relationships with compatible others. The education environment, including its ethnic diversity, impacted on the opportunities to make connections. Students who were ethnically minoritised reported encountering challenges, especially in the clinical environment, and described the burden of these for them. DISCUSSION Curriculum designers should consider the time and space that is afforded to student interaction during course development, as finding compatible others with whom students can socially connect is important to balancing well-being with academic performance.
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Affiliation(s)
- Stephanie Bull
- Medical Education Innovation and Research Centre, Imperial College London, London, UK
- University of Exeter, Exeter, UK
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Inyang D, Madume R, Corriero AC, Sofela A, Osunronbi T. Trends in research grant applications and outcomes among medical students in the United Kingdom: a national self-reported cross-sectional survey. Postgrad Med J 2024; 100:106-111. [PMID: 37973405 DOI: 10.1093/postmj/qgad113] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2023] [Revised: 08/30/2023] [Accepted: 10/26/2023] [Indexed: 11/19/2023]
Abstract
BACKGROUND Research funding disparities contribute to clinical academic workforce inequalities. Hence, our study explores the association between student demographics and research grant application rates and outcomes among UK medical students. METHODS This is a national multicentre cross-sectional survey of UK medical students in the 2020-21 academic year. Multiple zero-inflated negative binomial regression and generalized linear model (binomial distribution; logit link) were utilized to investigate the association between student demographics, number of grant applications submitted, and successful grant applications (yes or no). P-values less than a Bonferroni-corrected significance level of 0.05/36 = 0.0014 were considered to be statistically significant. RESULTS A total of 1528 students participated from 36 medical schools. One hundred fifty-one respondents (9.9%) had applied for research grants. Black students submitted applications 2.90 times more often than white students [Incident rate ratio (IRR): 2.90, 95% confidence interval (CI): 1.37-6.16], with no ethnic disparity in the odds of successful applications. Gender did not influence application rates significantly (P = .248), but women were 4.61 times more likely to secure a grant than men [odds ratio: 4.61, 95% CI: 2.04-10.4]. Being a PubMed-indexed author was associated with increased grant application submission rates [IRR: 3.61, 95% CI: 2.20- 5.92] while conducting more research was associated with greater odds of securing a grant [odds ratio: 1.42, 95% CI: 1.17- 1.73]. CONCLUSION Although black students submitted more applications, ethnicity did not influence success rates. Gender did not influence application rates, but women were more successful. These findings underscore the need for strategies supporting women and underrepresented students for continued academic achievement after graduation. KEY MESSAGES What is already known on this topic Research funding for post-PhD researchers is believed to be a major driver of gender and ethnic inequalities in the clinical academic workforce.Students who receive research grants are more likely to receive postgraduate research grants.What this study adds Black students applied for more research grants than white students, but there were no ethnic differences in the odds of securing a grant.There were no gender differences in the research grant application rates. However, female students had greater odds of securing research grants compared to male students.How this study might affect research, practice or policy Medical schools should incorporate grant writing skills into the undergraduate research curriculum. Also, to sustain women's academic success post medical school, the NIHR and affiliates should provide research award extensions and childcare support for women when required.
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Affiliation(s)
- Deborah Inyang
- Melanin Medics Research Network, Luton LU4 8DY, United Kingdom
- GKT School of Medical Education, King's College London, London SE1 1UL, United Kingdom
| | - Rachael Madume
- Melanin Medics Research Network, Luton LU4 8DY, United Kingdom
- Kent and Medway Medical School, Kent CT2 7FS, United Kingdom
| | - Anna Chiara Corriero
- Melanin Medics Research Network, Luton LU4 8DY, United Kingdom
- School of Medicine, Anglia Ruskin University, Chelmsford CM1 1SQ, United Kingdom
| | - Agbolahan Sofela
- Faculty of Health, University of Plymouth, Plymouth PL6 8BT, United Kingdom
| | - Temidayo Osunronbi
- Department of Health Sciences, University of York, York YO10 5DD, United Kingdom
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Barootes HC, Huynh ACA, Maracle M, Istl AC, Wang P, Kirpalani A. "Reduced to My Race Once Again": Perceptions about Underrepresented Minority Medical School Applicants in Canada and the United States. TEACHING AND LEARNING IN MEDICINE 2024; 36:1-12. [PMID: 36351290 DOI: 10.1080/10401334.2022.2141247] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/13/2021] [Accepted: 10/13/2022] [Indexed: 06/16/2023]
Abstract
Phenomenon: To increase racial diversity in medical school classes, many institutions have created underrepresented minority (URM) application streams. However, many URM students experience overt and passive marginalization throughout their training and this may be related to how matriculants from URM streams are perceived by their peers. Approach: We conducted a discourse analysis of online discussion forums to explore how URM streams across Canada and the United States are perceived. We analyzed 850 posts from 13 discussion threads published between 2015 and 2020. We used inductive content analysis to develop a data-driven coding scheme from which we identified common themes. Findings: Despite an overall appreciation of the benefits of a diverse workforce, participants engaged in prominent discussions surrounding the merits of URM streams. We identified perceptions that students admitted from URM streams are less academically and clinically competent, with URM applicants reporting feeling unworthy for admission in the eyes of non-URM applicants. Users felt that the influence of socioeconomic status was under-appreciated, and that admissions officers inadequately addressed this barrier. There were some applicants who perceived the admissions process as "broken" with non-URMs displaying a fear of social change, and URMs fearing that the system defines them by their racialized status. Insights: Online discussion forums provide unique insight into perceptions surrounding URM streams. We identified potentially harmful misconceptions about URM students applying to these streams and highlight that actionable measures to reduce marginalization against URM matriculants must begin before medical school.
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Affiliation(s)
- Hailey C Barootes
- Department of Paediatrics, Schulich School of Medicine and Dentistry, Western University, London, Ontario, Canada
- Children's Hospital, London Health Sciences Centre, London, Ontario, Canada
| | - Albert Cong-Anh Huynh
- Department of Paediatrics, Schulich School of Medicine and Dentistry, Western University, London, Ontario, Canada
| | - Marcy Maracle
- Department of Paediatrics, Schulich School of Medicine and Dentistry, Western University, London, Ontario, Canada
| | - Alexandra C Istl
- Department of Surgery, Medical College of Wisconsin, Milwaukee, Wisconsin, USA
| | - Peter Wang
- Children's Hospital, London Health Sciences Centre, London, Ontario, Canada
- Department of Surgery, Schulich School of Medicine and Dentistry, Western University, London, Ontario, Canada
| | - Amrit Kirpalani
- Department of Paediatrics, Schulich School of Medicine and Dentistry, Western University, London, Ontario, Canada
- Children's Hospital, London Health Sciences Centre, London, Ontario, Canada
- Lawson Health Research Institute, London, Ontario, Canada
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Ravulapalli KC, Arroyave Caicedo NM, Zahra D, Mirza M. Quantitative Analysis of Challenges Encountered by UK Widening Participation Medical Students in Comparison With Their Non-Widening Participation Peers. JOURNAL OF MEDICAL EDUCATION AND CURRICULAR DEVELOPMENT 2024; 11:23821205241249012. [PMID: 38808124 PMCID: PMC11131392 DOI: 10.1177/23821205241249012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 12/22/2023] [Accepted: 04/05/2024] [Indexed: 05/30/2024]
Abstract
OBJECTIVES Few studies have captured the experiences of widening participation (WP) medical students, and none have compared their experiences to their non-WP peers. This study aims to identify which challenges WP students are more likely to face. METHODS A 22-item questionnaire was distributed to medical students across all UK medical schools. Students were asked yes or no questions on whether they faced challenges in finances, socializing, physical and mental health, academic attainment, and COVID19-related teaching changes. RESULTS One-hundred seventy-six medical students from all year groups across the UK responded, with 97 students from a WP background. WP students were significantly more likely to have their personal background impacting their mental health (OR = 2.65, WP = 0.002), more than twice as likely to feel that their job impacted their studies (OR = 2.53, P ≤.05), more likely to feel limited by their financial situation (OR = 2.29, P≤.05) and to receive support from student finance (OR = 2.08, P < .05). CONCLUSION WP students were more likely to face challenges in mental health and finances in medical school compared to their peers. These findings, further informed by qualitative insights can aid in advancing equity in medical training.
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Brown C, Goss C, Sam AH. Is the awarding gap at UK medical schools influenced by ethnicity and medical school attended? A retrospective cohort study. BMJ Open 2023; 13:e075945. [PMID: 38086586 PMCID: PMC10753756 DOI: 10.1136/bmjopen-2023-075945] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/23/2023] [Accepted: 10/31/2023] [Indexed: 12/18/2023] Open
Abstract
OBJECTIVES To better characterise the Awarding Gap (AG) between black, Asian and other minority ethnic (BAME) and white students in UK undergraduate medical education by examining how it affects eight minority ethnicity subgroups (Bangladeshi, black, Chinese, Indian, Pakistani, mixed, other Asian background and other ethnic background) and whether the AG varies by medical school attended. DESIGN Retrospective cohort study. SETTING Data extracted from the UK Medical Education Database on students enrolled at 33 UK medical schools in the academic years starting 2012, 2013 and 2014. PARTICIPANTS 16 020 'Home' tuition fee status students who sat the University Clinical Aptitude Test on entry to university and obtained a UK Foundation Programme (UKFP) application score on exit. PRIMARY OUTCOME MEASURE UKFP Z-scores on exit from medical school. RESULTS There were significant differences in UKFP Z-scores between ethnicity subgroups. After white students, mixed ethnicity students performed best (coefficient -0.15 standard deviations [SD]) compared with white students, (95% confidence interval [CI] -0.23 to -0.08, p<0.001) and Pakistani students scored lowest (coefficient -0.53 SD, 95% CI -0.60 to -0.46, p<0.001). In pairwise comparisons of scores between all nine individual ethnicity subgroups, 15/36 were statistically significant. The AG varied considerably across medical schools. The largest gap showed the coefficient for BAME was -0.83 SD compared with white students (95% CI -1.18 to -0.49, p<0.001), while the smallest demonstrated no statistically significant difference in performance between BAME and white students (+0.05 SD, 95% CI -0.32 to 0.42, p=0.792). CONCLUSIONS BAME students are significantly disadvantaged by the current UK medical education system. There are clear differences in medical school outcomes between students from different ethnicity subgroups, and the size of the AG also varies by medical school attended. Urgent and effective action must be taken to address the AG and achieve an equal learning environment for our future doctors.
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Affiliation(s)
- Celia Brown
- Warwick Medical School (WMS), The University of Warwick, Coventry, UK
| | - Charlotte Goss
- Faculty of Medicine, Imperial College London, London, UK
| | - Amir H Sam
- Faculty of Medicine, Imperial College London, London, UK
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Guitard P, Toal-Sullivan D. The influence of occupational therapy students' preferred language on academic and clinical performance in a Canadian university program. ADVANCES IN HEALTH SCIENCES EDUCATION : THEORY AND PRACTICE 2023; 28:1615-1632. [PMID: 37222885 DOI: 10.1007/s10459-023-10226-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/12/2022] [Accepted: 03/19/2023] [Indexed: 05/25/2023]
Abstract
The Occupational Therapy Program at this Canadian university is a French program however, students must be bilingual to function in English or French clinical fieldwork settings. An understanding of the role of language in successful completion of program requirements was needed to effectively support students' education. The study objectives were to identify the role of linguistic factors in students' academic and clinical performance and to provide recommendations for strategies to address areas of learning difficulty. A multimethod approach used 4 data sources: (1) Multiple Mini Interview (MMI) informal language assessment scores, (2) grade point average (GPA), (3) fieldwork evaluation reports, and (4) an online survey of program graduates. The GPA on admission and MMI scores of 140 students predicted respectively only 20% and 2% of the variation in GPA on program completion. The areas of poorest performance in failed clinical fieldwork reports were in clinical reasoning and communication competencies. Among survey respondents (n = 47), 44.5% reported that a clinical placement in their second language with related charting (51.6%) and client communication (40.9%) were the most significant difficulties encountered in the program. Clients with mental health issues (45.4%) were the most challenging population to work with, attributed to communication barriers in the students' second language. Strategies are proposed to support occupational therapy students' academic and clinical language proficiency, including conversational training courses, problem-based learning activities in students' second language, focussed teaching on the clinical reasoning process and reflective skills, and language coaching to address early signs of difficulty in clinical fieldwork.
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Affiliation(s)
- Paulette Guitard
- Faculty of Health Sciences, University of Ottawa, Guindon Hall, Room 3059, 451 Smyth Road, Ottawa, ON, K1H 8M5, Canada
| | - Darene Toal-Sullivan
- School of Rehabilitation Sciences, Occupational Therapy Program, University of Ottawa, Guindon Hall, 451 Smyth Road, Ottawa, ON, K1H 8M5, Canada.
- , Almonte, Canada.
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Time WS, Samalia L, Wibowo E. Anatomical sciences education needs to promote academic excellence of ethnic minority students-Evidence from Pasifika students at the University of Otago. ANATOMICAL SCIENCES EDUCATION 2023; 16:1011-1023. [PMID: 37501349 DOI: 10.1002/ase.2319] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/14/2023] [Revised: 06/22/2023] [Accepted: 06/26/2023] [Indexed: 07/29/2023]
Abstract
The Department of Anatomy at the University of Otago offers anatomical sciences education for various programs, but currently, little information is available on how the academic performance of anatomy students differ based on ethnicities. Here, we aim to determine if there is an ethnic disparity in academic performance among anatomy students at the University of Otago. We conducted a 5-year review of academic performance of New Zealand European (NZE) and Pasifika students in 10 undergraduate anatomy courses, including clinical anatomy, neuroscience, reproduction, cell biology, and biological anthropology. NZE students achieved higher marks than Pasifika students in each academic year for four courses and in 3-4 of 5 academic years for the remaining courses. In eight courses, there were higher proportions of Pasifika students than NZE students who repeated the courses (in 4-5 of 5 academic years for two courses, in 1-2 of 5 academic years for six courses). Multiple regression analyses showed that Pasifika students were more likely to achieve lower marks than NZE students in all courses. Other predictors for academic marks included year of study for five courses, age for three courses, international student status for two courses, major specialization for eight courses, home location for one course, and gender for one course. Data from this research provide evidence that ethnic inequity may exist in anatomical sciences education, and can be used by institutions globally to justify evaluating their anatomy programs, with the aim to better support ethnic minority students who may be struggling academically.
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Affiliation(s)
| | - Latika Samalia
- Department of Anatomy, University of Otago, Dunedin, New Zealand
| | - Erik Wibowo
- Department of Anatomy, University of Otago, Dunedin, New Zealand
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Adeboye W, Osunronbi T, Faluyi D, Abankwa E, Abraha S, Adamu-Biu F, Ahmad Z, Akhionbare I, Chimba C, Corriero AC, Ibeanusi I, Inyang D, Jones R, Madume R, Mberu V, Mitoko CA, Nelson-Rowe E, O'Riordan M, Shoker S, Sofela A. Predictors of self-reported research engagement and academic-career interest amongst medical students in the United Kingdom: a national cross-sectional survey. Postgrad Med J 2023; 99:1189-1196. [PMID: 37594075 DOI: 10.1093/postmj/qgad067] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2023] [Revised: 07/14/2023] [Accepted: 07/18/2023] [Indexed: 08/19/2023]
Abstract
BACKGROUND We hypothesised that the gender/ethnic disparities and reductions in the UK academic-clinician workforce stem from research experience in medical school. This study investigated the factors influencing research engagement and academic-career interests among UK medical students. METHODS Using a 42-item online questionnaire, a national multicentre cross-sectional survey of UK medical students was conducted over 9 weeks in the 2020/21 academic year. Multiple binary logistic and zero-inflated negative binomial regressions were used to evaluate associations between the predictor variables and research engagement (yes/no), number of research projects conducted, and academic-career interest (yes/no). P < 0.05 was considered statistically significant. RESULTS In total, 1573 students participated from 36 medical schools. No ethnic/gender differences in research engagement were observed. However, compared to men, women had a 31% decrease in the odds of being interested in an academic-clinician career [odds ratio (OR): 0.69; 95% confidence interval (CI): 0.52, 0.92]. Positive predictors of interest in academia were being a PubMed-indexed author (OR: 2.19; 95% CI: 1.38, 3.47) and having at least one national/international presentation (OR: 1.40; 95% CI: 1.04, 1.88). Career progression was the primary motivating factor (67.1%) for pursuing research, whereas limited awareness of opportunities (68.0%) and time constraints (67.5%) were the most common barriers. CONCLUSION There were no ethnic differences in research engagement or academic-career intent. Although there were no gender differences in research engagement, female students were less likely to be interested in an academic career. This could be tackled by providing targeted opportunities to increase research productivity and self-efficacy in medical schools. Key messages: What is already known on this topic: There has been a decline in the number of academic clinicians, with a disproportionate gender and ethnic representation in the academic workforce. Engaging medical students in research activities during their medical training could mitigate the declining number of academic clinicians. Differential attainment occurs in medical school and persists after graduation. What this study adds: Although there were no gender/ethnic differences in research engagement amongst UK medical students, our study suggests that female students were less likely to be interested in pursuing an academic career. Time constraints, a lack of awareness of opportunities, and difficulty in finding research supervisors/mentors were the most common barriers to research engagement, whereas PubMed-indexed authorship was the strongest positive predictor of interest in an academic career. How this study might affect research, practice, or policy: Medical schools should facilitate the selection of good-quality research mentors that would provide adequate support to ensure that their students' works are published in peer-reviewed journals. Medical schools should employ local research officers to increase students' awareness of research opportunities.
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Affiliation(s)
- William Adeboye
- Melanin Medics Research Network, Luton, LU4 8DY, United Kingdom
| | | | - David Faluyi
- Melanin Medics Research Network, Luton, LU4 8DY, United Kingdom
| | - Efua Abankwa
- Melanin Medics Research Network, Luton, LU4 8DY, United Kingdom
| | - Semhar Abraha
- Melanin Medics Research Network, Luton, LU4 8DY, United Kingdom
| | | | - Zain Ahmad
- Melanin Medics Research Network, Luton, LU4 8DY, United Kingdom
| | | | - Chimba Chimba
- Melanin Medics Research Network, Luton, LU4 8DY, United Kingdom
| | - Anna C Corriero
- Melanin Medics Research Network, Luton, LU4 8DY, United Kingdom
| | - Ikenna Ibeanusi
- Melanin Medics Research Network, Luton, LU4 8DY, United Kingdom
| | - Deborah Inyang
- Melanin Medics Research Network, Luton, LU4 8DY, United Kingdom
| | - Robert Jones
- Melanin Medics Research Network, Luton, LU4 8DY, United Kingdom
| | - Rachael Madume
- Melanin Medics Research Network, Luton, LU4 8DY, United Kingdom
| | - Valentine Mberu
- Melanin Medics Research Network, Luton, LU4 8DY, United Kingdom
| | | | | | | | - Serena Shoker
- Melanin Medics Research Network, Luton, LU4 8DY, United Kingdom
| | - Agbolahan Sofela
- Faculty of Health, University of Plymouth, Plymouth, PL6 8BT, United Kingdom
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12
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Morrison N, Machado M, Blackburn C. Bridging the gap: Understanding the barriers and facilitators to performance for Black, Asian and Minority Ethnic medical students in the United Kingdom. MEDICAL EDUCATION 2023. [PMID: 37807122 DOI: 10.1111/medu.15246] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/10/2023] [Revised: 09/11/2023] [Accepted: 09/15/2023] [Indexed: 10/10/2023]
Abstract
INTRODUCTION Differential attainment is a well-known phenomenon in medical education. Despite a strong impetus for institutions and researchers to move away from a 'student deficit model' when exploring the attainment gap, little attention has been given to understanding the experiences of Black, Asian and Minority Ethnic (BAME) medical students. Informed by the social construction of learning theory, this is the first national study to explore how multiple dimensions of the medical school environment impact academic performance of BAME undergraduate medical students across the UK. METHODS Using a sequential explanatory mixed-methods approach, the authors conducted a survey and facilitated three focus groups across medical schools in the UK between 2020-2021. Participants self-identified as being from BAME backgrounds. Quantitative analyses included descriptive statistics and bivariate analyses. Qualitative data were analysed using thematic analysis, subsequently identifying inductive themes. RESULTS Three hundred sixty-two respondents completed the Phase 1 survey, and 17 participants participated in the Phase 2 focus groups. Although both survey and focus group participants identified facilitators to learning such as supportive relationships, students reported facing numerous barriers that they felt impeded their learning and performance. These barriers included limited access to educational resources, and undiversified curricula and medical school populations. Students also described both experiencing and witnessing various forms of racism throughout their educational journeys. DISCUSSION Students encountered various difficulties throughout their medical training that they felt impacted their learning and performance. This study offers novel insights into the experiences of BAME students and builds upon previous research. It also reveals the pervasive nature of racism within medical schools, highlighting the urgent need for institutional changes. Educators and institutions must go beyond merely recognising these barriers and facilitators; they must proactively innovate and adapt. In doing so, they pave the way for inclusive learning environments that truly foster a sense of belonging for BAME students.
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Affiliation(s)
- Nariell Morrison
- Division of Health Sciences, Warwick Medical School, University of Warwick, Coventry, UK
- Department of Education, University of Oxford, Oxford, UK
| | - Michelle Machado
- Division of Health Sciences, Warwick Medical School, University of Warwick, Coventry, UK
| | - Clare Blackburn
- Division of Health Sciences, Warwick Medical School, University of Warwick, Coventry, UK
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Byrne MHV, Yale SE, Glasbey M, Revell E, Brown MEL. All medical degrees are equal, but some are more equal than others: An analysis of medical degree classifications. MEDICAL EDUCATION 2023; 57:732-740. [PMID: 36642926 DOI: 10.1111/medu.15019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/18/2022] [Revised: 01/07/2023] [Accepted: 01/11/2023] [Indexed: 06/17/2023]
Abstract
BACKGROUND Inequity in assessment can lead to differential attainment. Degree classifications, such as 'Honours', are an assessment outcome used to differentiate students after graduation. However, there are no standardised criteria used to determine what constitutes these awards. METHODS We contacted all medical schools in the UK and collected data relating to classifications awarded, criteria used and percentage of students receiving classifications across the 5-year period prior to the 2019/2020 academic year. RESULTS All 42 UK medical schools responded, and 36 universities provided usable data. Of these 36 universities, 30 (83%) awarded classifications above a 'Pass'. We identified four classifications above a 'Pass', and these were 'Commendation', 'Merit', 'Distinction' and 'Honours'. Sixteen (44%) universities awarded a single additional classification, and 14 (39%) universities awarded two or more. There was considerable variation in the criteria used by each university to award classifications. For example, 30 (67%) out of 45 classifications were dependent on all examined years, 9 (20%) for a combination of years and 6 (13%) for final year alone. Twenty-five of 30 universities that awarded classifications provided data on the percentage of students awarded a classification, and a median of 15% of students received any type of classification from their university (range 5.3% to 38%). There was a wide range in the percentage of students awarded each classification type across the universities (e.g. Honours, range = 3.1%-24%). CONCLUSIONS We demonstrate considerable variation in the way UK medical degree classifications are awarded-regarding terminology, criteria and percentage of students awarded classifications. We highlight that classifications are another form of inequity in medical education. There is a need to fully evaluate the value of hierarchical degree awards internationally as the consequential validity of these awards is understudied.
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Affiliation(s)
- Matthew H V Byrne
- Nuffield Department of Surgical Sciences, University of Oxford, Oxford, UK
| | - Sophie E Yale
- Newcastle Medical School, Newcastle University, Newcastle upon Tyne, UK
| | | | - Elliot Revell
- Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, UK
| | - Megan E L Brown
- Medical Education Innovation and Research Centre, Imperial College London, London, UK
- Faculty of Medicine and Health Sciences and Allied Health, University of Buckingham, Buckingham, UK
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Maimouni H, Mistry K, Sivanesan O, Asif H, Clark A, Vassilou VS. Impact of the increase in tuition fees and demographic factors on medical student intercalation rates between 2006 and 2020. Future Healthc J 2023; 10:137-142. [PMID: 37786643 PMCID: PMC10540793 DOI: 10.7861/fhj.2023-0019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/04/2023]
Abstract
Introduction No quantitative research has assessed the trends in English medical student intercalation. In addition, the impacts of the increase in tuition fees, introduced in 2012, and demographic factors on intercalation rates are unknown. Methods Freedom of information requests were sent to all UK universities. Regression analysis compared intercalation rates before (2006-2012) and after (2012-2020) the tuition fee increase. Student's t-tests compared demographics of medical students who intercalated. Questionnaires were sent to all UK universities to explore reasons for intercalating. Results In total, 101,085 students from seven universities responded. The intercalation rate increased from 4.70% to 10.53% (mean percentage difference (MPD) 5.84; 95% confidence interval (CI) 2.94-8.73). Intercalating students were more likely to be <25 years of age (MPD 33.36%; 95%CI 28.34-38.39), without a previous degree (MPD 8.56%; 95% CI 7.00-10.11) and without a disability (MPD 3.15%; 95% CI 0.88-5.42). In total, 389 completed questionnaires were received from 10 universities. Medical students believed an intercalated degree made them a better doctor. Discussion The proportion of students who intercalated was greater following the increase in tuition fees. This might be explained by the value medical that students placed on the skills and opportunities that accompany an intercalated degree.
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Affiliation(s)
- Hassan Maimouni
- Norwich Medical School, University of East Anglia, Norwich, UK
| | - Khaylen Mistry
- Norfolk and Norwich University Hospital, Norwich, UK, and honorary tutor, Norwich Medical School, University of East Anglia, Norwich, UK
| | | | - Haysum Asif
- Norwich Medical School, University of East Anglia, Norwich, UK
| | - Allan Clark
- Norwich Medical School, University of East Anglia, Norwich, UK
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Babiker S, Ogunmwonyi I, Georgi MW, Tan L, Haque S, Mullins W, Singh P, Ang N, Fu H, Patel K, Khera J, Fricker M, Fleming S, Giwa-Brown L, A Brennan P, Irune E, Vig S, Nathan A. Variation in Experiences and Attainment in Surgery Between Ethnicities of UK Medical Students and Doctors (ATTAIN): Protocol for a Cross-Sectional Study. JMIR Res Protoc 2023; 12:e40545. [PMID: 37327055 DOI: 10.2196/40545] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2022] [Revised: 04/18/2023] [Accepted: 05/03/2023] [Indexed: 06/17/2023] Open
Abstract
BACKGROUND The unequal distribution of academic and professional outcomes between different minority groups is a pervasive issue in many fields, including surgery. The implications of differential attainment remain significant, not only for the individuals affected but also for the wider health care system. An inclusive health care system is crucial in meeting the needs of an increasingly diverse patient population, thereby leading to better outcomes. One barrier to diversifying the workforce is the differential attainment in educational outcomes between Black and Minority Ethnic (BME) and White medical students and doctors in the United Kingdom. BME trainees are known to have lower performance rates in medical examinations, including undergraduate and postgraduate exams, Annual Review of Competence Progression, as well as training and consultant job applications. Studies have shown that BME candidates have a higher likelihood of failing both parts of the Membership of the Royal Colleges of Surgeons exams and are 10% less likely to be considered suitable for core surgical training. Several contributing factors have been identified; however, there has been limited evidence investigating surgical training experiences and their relationship to differential attainment. To understand the nature of differential attainment in surgery and to develop effective strategies to address it, it is essential to examine the underlying causes and contributing factors. The Variation in Experiences and Attainment in Surgery Between Ethnicities of UK Medical Students and Doctors (ATTAIN) study aims to describe and compare the factors and outcomes of attainment between different ethnicities of doctors and medical students. OBJECTIVE The primary aim will be to compare the effect of experiences and perceptions of surgical education of students and doctors of different ethnicities. METHODS This protocol describes a nationwide cross-sectional study of medical students and nonconsultant grade doctors in the United Kingdom. Participants will complete a web-based questionnaire collecting data on experiences and perceptions of surgical placements as well as self-reported academic attainment data. A comprehensive data collection strategy will be used to collect a representative sample of the population. A set of surrogate markers relevant to surgical training will be used to establish a primary outcome to determine variations in attainment. Regression analyses will be used to identify potential causes for the variation in attainment. RESULTS Data collected between February 2022 and September 2022 yielded 1603 respondents. Data analysis is yet to be competed. The protocol was approved by the University College London Research Ethics Committee on September 16, 2021 (ethics approval reference 19071/004). The findings will be disseminated through peer-reviewed publications and conference presentations. CONCLUSIONS Drawing upon the conclusions of this study, we aim to make recommendations on educational policy reforms. Additionally, the creation of a large, comprehensive data set can be used for further research. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID) DERR1-10.2196/40545.
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Affiliation(s)
| | | | - Maria W Georgi
- University College London Medical School, London, United Kingdom
| | | | - Sharmi Haque
- Faculty of Health, Medicine and Life Sciences, Maastricht University, Maastricht, Netherlands
| | - William Mullins
- St Georges University Hospital National Health Service Trust, London, United Kingdom
| | - Prisca Singh
- University of Birmingham Medical School, Birmingham, United Kingdom
| | - Nadya Ang
- Barts and The London School of Medicine and Dentistry, London, United Kingdom
| | - Howell Fu
- South West London Elective Orthopaedic Centre, London, United Kingdom
| | - Krunal Patel
- University College London Medical School, London, United Kingdom
| | - Jevan Khera
- University Hospital Coventry & Warwickshire, Coventry, United Kingdom
| | | | - Simon Fleming
- Institute of Health Sciences Education, Queen Mary University of London, London, United Kingdom
| | - Lolade Giwa-Brown
- Barts Health National Health Service Trust, Royal London Hospital, London, United Kingdom
| | - Peter A Brennan
- Maxillofacial Unit, Queen Alexandra Hospital, Portsmouth, United Kingdom
| | - Ekpemi Irune
- Department of Otolaryngology, Head and Neck Surgery, Cambridge University Hospitals National Health Service Foundation, Cambridge, United Kingdom
| | - Stella Vig
- Department of Vascular and General Surgery, Croydon University Hospital, London, United Kingdom
| | - Arjun Nathan
- Division of Surgery and Interventional Sciences, University College London, London, United Kingdom
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Osunronbi T, Adeboye W, Faluyi D, Sofela J, Abankwa E, Abraha S, Adamu-Biu F, Ahmad Z, Akhionbare I, Chimba C, Corriero AC, Fofanah IJ, Ibeanusi I, Ibrahim U, Inyang D, Jones R, Kolawole A, Madume R, Mandangu C, Mberu V, Nelson-Rowe E, O'Riordan M, Shoker S, Sofela A. Predictors of self-reported research productivity amongst medical students in the United Kingdom: a national cross-sectional survey. BMC MEDICAL EDUCATION 2023; 23:412. [PMID: 37280642 DOI: 10.1186/s12909-023-04412-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/19/2022] [Accepted: 05/30/2023] [Indexed: 06/08/2023]
Abstract
BACKGROUND The number of academic clinicians in the UK is declining and there are demographic inequalities in the clinical-academic workforce. Increased research productivity by medical students is believed to reduce future attrition in the clinical-academic workforce. Thus, this study investigated the association between student demographics and research productivity amongst UK medical students. METHODS This is a national multicentre cross-sectional study of UK medical students in the 2020/21 academic year. We appointed one student representative per medical school, and they disseminated a 42-item online questionnaire over nine weeks, through departmental emails and social media advertisements. The outcome measures were: (i) publications (yes/no) (ii) number of publications (iii) number of first-authored publications (iv) abstract presentation (yes/no). We utilised multiple logistic and zero-inflated Poisson regression analyses to test for associations between the outcome measures and predictor variables at a 5% significance level. RESULTS There are 41 medical schools in the UK. We received 1573 responses from 36 UK medical schools. We failed to recruit student representatives from three newly formed medical schools, whilst two medical schools prohibited us from sending the survey to their students. Women had lower odds of having a publication (OR: 0.53, 95% CI: 0.33-0.85) and on average had fewer first-author publications than men (IRR: 0.57, 95% CI: 0.37-0.89). Compared to white students, mixed-ethnicity students had greater odds of having a publication (OR: 3.06, 95% CI: 1.67-5.59), an abstract presentation (OR: 2.12, 95% CI: 1.37-3.26), and on average had a greater number of publications (IRR: 1.87, 95% CI: 1.02-3.43). On average, students who attended independent UK secondary schools had a higher rate of first-author publications compared to those that attended state secondary schools (IRR: 1.97, 95% CI: 1.23-3.15). CONCLUSION Our data suggest that there are gender, ethnic and socioeconomic inequalities in research productivity among UK medical students. To tackle this, and potentially improve diversity in clinical academia, we recommend that medical schools should facilitate targeted high quality research mentorship, funding and training, especially for under-represented-in-medicine students.
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Affiliation(s)
- Temidayo Osunronbi
- Melanin Medics Research Network, Luton, UK
- Department of Health Sciences, University of York, York, UK
| | | | | | | | | | | | | | - Zain Ahmad
- Melanin Medics Research Network, Luton, UK
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | - Agbolahan Sofela
- Faculty of Health, University of Plymouth, Plymouth, UK.
- Southwest Neurosurgery Centre, University Hospitals Plymouth NHS Trust, Plymouth, PL6 8DH, UK.
- School of Medicine, University of Exeter Medical School, Exeter, EX1 2HZ, UK.
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Elmansouri A, Curtis S, Nursaw C, Smith D. How do the post-graduation outcomes of students from gateway courses compare to those from standard entry medicine courses at the same medical schools? BMC MEDICAL EDUCATION 2023; 23:298. [PMID: 37131153 PMCID: PMC10152708 DOI: 10.1186/s12909-023-04179-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/05/2022] [Accepted: 03/20/2023] [Indexed: 05/04/2023]
Abstract
BACKGROUND Widening participation (WP) for underrepresented students through six-year gateway courses helps to widen the demographic representation of doctors in the UK. 'Most students from gateway courses graduate, even though many enter with lower grades than standard entry medicine students.' This study aims to compare the graduate outcomes of gateway and SEM cohorts from the same universities. METHODS Data from 2007-13 from the UK Medical Education Database (UKMED) were available for graduates of gateway and SEM courses at three UK medical schools. Outcome measures were passing an entry exam on the first attempt, Annual Review of Competency Progression (ARCP) outcome and being offered a level one training position from the first application. The univariate analysis compared the two groups. Logistic regressions, predicting outcomes by course type, controlled for attainment on completion of medical school. RESULTS Four thousand four hundred forty-five doctors were included in the analysis. There was no difference found in the ARCP outcome between gateway and SEM graduates. Gateway graduates were less likely to pass their first attempt at any membership exam than graduates of SEM courses (39% vs 63%). Gateway graduates were less likely to be offered a level 1 training position on their first application (75% vs 82%). Graduates of gateway courses were more likely to apply to General Practitioner (GP) training programmes than SEM graduates (56% vs 39%). CONCLUSIONS Gateway courses increase the diversity of backgrounds represented within the profession and importantly the number of applications to GP training. However, differences in cohort performance are shown to continue to exist in the postgraduate arena and further research is required to ascertain the reasons for this.
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Affiliation(s)
- Ahmad Elmansouri
- Medical Education, Faculty of Medicine, University of Southampton, Southampton, SO17 IBJ, England, UK.
| | - Sally Curtis
- Medical Education, Faculty of Medicine, University of Southampton, Southampton, SO17 IBJ, England, UK
| | - Ceri Nursaw
- Nursaw Associates, Coventry, CV1 2TT, England, UK
| | - Daniel Smith
- General Medical Council, London, NW1 3JN, England, UK
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van Moppes NM, Willems S, Nasori M, Bont J, Akkermans R, van Dijk N, van den Muijsenbergh M, Visser M. Ethnic minority GP trainees at risk for underperformance assessments: a quantitative cohort study. BJGP Open 2023; 7:BJGPO.2022.0082. [PMID: 36343966 DOI: 10.3399/bjgpo.2022.0082] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2022] [Revised: 09/20/2022] [Accepted: 09/28/2022] [Indexed: 11/09/2022] Open
Abstract
BACKGROUND Recent studies suggest that ethnic minority students underperform in standardised assessments commonly used to evaluate their progress. This disparity seems to also hold for postgraduate medical students and GP trainees, and may affect the quality of primary health care, which requires an optimally diverse workforce. AIMS To address the following: 1) to determine to what extent ethnic minority GP trainees are more at risk of being assessed as underperforming than their majority peers; 2) to investigate whether established underperformance appears in specific competence areas; and 3) to explore first- and second-generation ethnic minority trainees' deviations. DESIGN & SETTING Quantitative retrospective cohort design in Dutch GP specialty training (start years: 2015-2017). METHOD In 2020-2021, the authors evaluated files on assessed underperformance of 1700 GP trainees at seven Dutch GP specialty training institutes after excluding five opt-outs and 165 incomplete datasets (17.4% ethnic minority trainees). Underperformance was defined as the occurrence of the following, which was prompted by the training institute: 1) preliminary dropout; 2) extension of the educational pathway; and/or 3) mandatory coaching pathways. Statistics Netherlands (CBS) anonymised the files and added data about ethnic group. Thereafter, the authors performed logistic regression for potential underperformance analysis and χ2 tests for competence area analysis. RESULTS Ethnic minority GP trainees were more likely to face underperformance assessments than the majority group (odds ratio [OR] 2.41, 95% confidence interval [CI] = 1.67 to 3.49). Underperformance was not significantly nested in particular competence areas. First-generation ethnic minority trainees seemed more at risk than their second-generation peers. CONCLUSION Ethnic minority GP trainees seem more at risk of facing educational barriers than the majority group. Additional qualitative research on underlying factors is essential.
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Affiliation(s)
- Nathanja Mariëtte van Moppes
- Department of General Practice, Amsterdam UMC, location AMC, Amsterdam, The Netherlands
- Quality of Care and Personalised Medicine, Amsterdam Public Health, Amsterdam, The Netherlands
| | - Sander Willems
- Emergency Department, Rijnstate Hospital, Arnhem, Nijmegen, The Netherlands
| | - Mana Nasori
- Department of General Practice, Amsterdam UMC, location AMC, Amsterdam, The Netherlands
- Quality of Care and Personalised Medicine, Amsterdam Public Health, Amsterdam, The Netherlands
| | - Jettie Bont
- Department of General Practice, Amsterdam UMC, location AMC, Amsterdam, The Netherlands
- Quality of Care and Personalised Medicine, Amsterdam Public Health, Amsterdam, The Netherlands
| | - Reinier Akkermans
- Department of Primary and Community Care, Radboud Institute for Health Sciences, Scientific Institute for Quality of Healthcare, Radboud University Medical Center, Radboud University Nijmegen, Nijmegen, The Netherlands
| | - Nynke van Dijk
- Faculties of Exercise & Sports, Nutrition, and Health, Amsterdam University of Applied Sciences, Amsterdam, The Netherlands
| | - Maria van den Muijsenbergh
- Department of General Practice, Radboud University Medical Center, Radboud University Nijmegen, Nijmegen, The Netherlands
| | - Mechteld Visser
- Department of General Practice, Amsterdam UMC, location AMC, Amsterdam, The Netherlands
- Quality of Care and Personalised Medicine, Amsterdam Public Health, Amsterdam, The Netherlands
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Kelly L, Sankaranarayanan S. Differential attainment: how can we close the gap in paediatrics? Arch Dis Child Educ Pract Ed 2023; 108:54-57. [PMID: 34857652 DOI: 10.1136/archdischild-2020-321066] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/31/2021] [Accepted: 11/11/2021] [Indexed: 02/05/2023]
Abstract
Differential attainment is the gap in attainment between different demographic groups undertaking the same assessment. Across the UK, we see differences in outcome in undergraduate and postgraduate medical education on the basis of gender, age, ethnicity and country of primary medical qualification which cannot be explained by a difference in ability. The largest gaps appear when we look at the variation in outcome between UK and international medical graduates (IMGs) and between white British and black, Asian and minority ethnic (BAME) doctors in postgraduate medical education. If we look to postgraduate medical examinations, the differences in attainment are stark and occur across all medical specialties, with paediatrics being no exception. The differences are also seen in the rates of relative success in recruitment to training posts and in a trainee's likelihood of getting a satisfactory outcome at the Annual Review of Competence Progression. Ensuring all doctors reach their full potential is undoubtedly an issue of fairness that is of particular significance to paediatrics as IMGs make up 47% of our medical workforce and 36% of the paediatric workforce identifies as being from a BAME group. It is clear that if we fail to close the gap in differential attainment, there will be both a personal cost to affected individuals, but also a cost to the wider paediatric profession and the children they serve. This paper hopes to summarise the background and causes to differential attainment and look towards possible interventions that might tackle this issue.
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Affiliation(s)
- Laura Kelly
- Paediatrics, Birmingham Women's and Children's NHS Foundation Trust, Birmingham, Birmingham, UK
| | - Sailesh Sankaranarayanan
- Postgraduate Medical and Dental Education, Health Education England West Midlands, Edgbaston, Birmingham, UK
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Al Asmri M, Haque MS, Parle J. A Modified Medical Education Research Study Quality Instrument (MMERSQI) developed by Delphi consensus. BMC MEDICAL EDUCATION 2023; 23:63. [PMID: 36698117 PMCID: PMC9878889 DOI: 10.1186/s12909-023-04033-6] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/08/2021] [Accepted: 01/16/2023] [Indexed: 05/13/2023]
Abstract
BACKGROUND The Medical Education Research Study Quality Instrument (MERSQI) is widely used to appraise the methodological quality of medical education studies. However, the MERSQI lacks some criteria which could facilitate better quality assessment. The objective of this study is to achieve consensus among experts on: (1) the MERSQI scoring system and the relative importance of each domain (2) modifications of the MERSQI. METHOD A modified Delphi technique was used to achieve consensus among experts in the field of medical education. The initial item pool contained all items from MERSQI and items added in our previous published work. Each Delphi round comprised a questionnaire and, after the first iteration, an analysis and feedback report. We modified the quality instruments' domains, items and sub-items and re-scored items/domains based on the Delphi panel feedback. RESULTS A total of 12 experts agreed to participate and were sent the first and second-round questionnaires. First round: 12 returned of which 11 contained analysable responses; second-round: 10 returned analysable responses. We started with seven domains with an initial item pool of 12 items and 38 sub-items. No change in the number of domains or items resulted from the Delphi process; however, the number of sub-items increased from 38 to 43 across the two Delphi rounds. In Delphi-2: eight respondents gave 'study design' the highest weighting while 'setting' was given the lowest weighting by all respondents. There was no change in the domains' average weighting score and ranks between rounds. CONCLUSIONS The final criteria list and the new domain weighting score of the Modified MERSQI (MMERSQI) was satisfactory to all respondents. We suggest that the MMERSQI, in building on the success of the MERSQI, may help further establish a reference standard of quality measures for many medical education studies.
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Affiliation(s)
- Mansour Al Asmri
- Clinical Skills Training Centre, King Fahad Specialist Hospital, Dammam, Saudi Arabia
| | - M Sayeed Haque
- Institute of Applied Health Research, University of Birmingham, Birmingham, B15 2TT, UK
| | - Jim Parle
- Institute of Clinical Sciences, College of Medical and Dental Sciences, University of Birmingham, Birmingham, B15 2TT, UK.
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Iacobucci G. Study finds no sign that gap in medical training attainment by ethnicity is shrinking. BMJ 2022; 379:o3027. [PMID: 36535697 DOI: 10.1136/bmj.o3027] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
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22
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Mukherji P, Adas MA, Clarke B, Galloway JB, Mulvey T, Norton S, Turner J, Russell MD, Lempp H, Li S. Changing trends in ethnicity and academic performance: observational cohort data from a UK medical school. BMJ Open 2022; 12:e066886. [PMID: 36521901 PMCID: PMC9756189 DOI: 10.1136/bmjopen-2022-066886] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/23/2022] Open
Abstract
OBJECTIVE Quantify differential attainment by ethnicity in undergraduate medical assessments and evaluate whether institutional efforts to reduce the attainment gap have had impact. DESIGN Observational cohort study. SETTING A single UK MBBS medical programme. PARTICIPANTS Pseudonymised data of adults aged ≥18 years enrolled in one of the UK MBBS medical programmes between 2012 and 2018. Ethnicity was self-declared during enrolment as White, Asian, Black, mixed and other. MAIN OUTCOME MEASURE Module mark (distinction, merit, pass, fail) graded according to a variety of assessments, including single best answer examinations, objective structured clinical examinations and coursework submissions. All modular assessments are graded as a percentage. Logistic regression models were used to calculate relative risk ratio to study the association between ethnicity and attainment gap over a calendar and scholastic year. Models were adjusted for age, gender, social deprivation and scholastic year of study. RESULTS 3714 student records were included. In the sample, 2134 students (57%) were non-white. The proportion of non-white students increased from 2007 (49%) to 2018 (70%). Mean age was 18 (IQR 18-21) and 56.6% were females. Higher proportion of non-white students 218 (24.8%) were from more deprived backgrounds versus white 76 (14.8%). Compared with non-white, there were no significant differences in the proportion of students failing assessments. However, white students were more likely to achieve merit (relative risk ratio 1.29 (95% CI 1.08 to 1.45)) or distinction (1.69 (95% CI 1.37 to 2.08)). Differences in attainment gap have remained unchanged over time, and for black students, attainment gap grew between their first and final year of study. CONCLUSION A similar proportion (97%) of non-white and white students had a passing score, but attainment gap for higher grades persists over years despite widespread efforts in medical schools to diminish the attainment gap linked to ethnicity. Our findings are from a single institution, thus affecting generalisability.
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Affiliation(s)
| | - Maryam A Adas
- Centre for Rheumatic Diseases, King's College London, London, UK
| | - Benjamin Clarke
- Postgraduate Medical & Dental Education Centre, King's College Hospital NHS Foundation Trust, London, UK
| | - James B Galloway
- Centre for Rheumatic Diseases, King's College London, London, UK
| | - Thomas Mulvey
- Clinical Education Department, King's College London, London, UK
| | - Sam Norton
- Psychology Department, Insitute of Psychiatry, King's College London, London, UK
| | - Jonathan Turner
- Clinical Education Department, King's College London, London, UK
| | - Mark D Russell
- Centre for Rheumatic Diseases, King's College London, London, UK
| | - Heidi Lempp
- Centre for Rheumatic Diseases, King's College London, London, UK
| | - Shuangyu Li
- Division of Medical Education, King's College London, London, UK
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Vattanavanit V, Ngudgratoke S, Khaninphasut P. Validation of response processes in medical assessment using an explanatory item response model. BMC MEDICAL EDUCATION 2022; 22:855. [PMID: 36496386 PMCID: PMC9737731 DOI: 10.1186/s12909-022-03942-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 08/30/2022] [Accepted: 12/05/2022] [Indexed: 06/17/2023]
Abstract
BACKGROUND Response process validation is a crucial source of test validity. The expected cognitive load scale was created based on the reflection of the mental effort by which borderline students solve an item defined by experts. The stem length affects the students' extraneous cognitive load. The purposes of this study were to develop an exam for medical students and corroborate the response process validity by analyzing the correlation between the expected cognitive load, stem length, and the difficulty. METHODS This was a correlational study. Five medical teachers as the experts and 183 third-year medical students were enrolled from the Faculty of Medicine, Prince of Songkla University, Thailand. The instruments used were a medical physiology exam and a three-level expected cognitive load evaluation form judged by medical teachers. Data were analyzed using an explanatory item response model. RESULTS The test consists of 20 items and 21 possible scores. The median score was 8, with a quartile deviation of 1.5. Nine items had long stems (more than two lines). Sixteen items were judged as high (level 2 or 3) expected cognitive load. When adding the expected cognitive load in a Rasch model, the expected cognitive load significantly correlated with item difficulty. In the Rasch model that included both the expected cognitive load and stem length, a long stem had a greater effect on item difficulty than low expected cognitive load. However, the Rasch model showed the best fit. CONCLUSIONS The long stem had a stronger correlation with test difficulty than expected cognitive load, which indirectly implied response process validity. We suggest incorporating stem length and expected cognitive load to create an appropriate distribution of the difficulty of the entire test.
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Affiliation(s)
- Veerapong Vattanavanit
- Educational Measurement and Evaluation Program, School of Educational Studies, Sukhothai Thammathirat Open University, Nonthaburi, 11120, Thailand.
- Faculty of Medicine, Prince of Songkla University, 15 Kanjanavanich Road, Hat Yai, Songkhla, 90110, Thailand.
| | - Sungworn Ngudgratoke
- Educational Measurement and Evaluation Program, School of Educational Studies, Sukhothai Thammathirat Open University, Nonthaburi, 11120, Thailand
| | - Purimpratch Khaninphasut
- Educational Measurement and Evaluation Program, School of Educational Studies, Sukhothai Thammathirat Open University, Nonthaburi, 11120, Thailand
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Lokugamage AU, Robinson N, Pathberiya SDC, Wong S, Douglass C. Respectful maternity care in the UK using a decolonial lens. SN SOCIAL SCIENCES 2022; 2:267. [PMID: 36531139 PMCID: PMC9734803 DOI: 10.1007/s43545-022-00576-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 08/30/2021] [Accepted: 11/23/2022] [Indexed: 06/17/2023]
Abstract
Respectful maternity care (RMC) is part of a global movement addressing the previous absence of human rights in global safe maternal care guidance. RMC is grounded in kindness, compassion, dignity and respectful working conditions. The decolonisation movement in healthcare seeks to dismantle structural biases set up from a historically white, male, heteronormative Eurocentric medical system. This article applies a decolonising lens to the RMC agenda and examines barriers to its implementation in UK healthcare systems. Searches of peer-reviewed journals about decolonising maternity care in the UK revealed little. Drawing from wider information bases, we examine power imbalances constructed throughout a history of various colonial biases yet lingering in maternity care. The overarching findings of our analysis revealed 3 areas of focus: professional structures and institutional biases; power imbalances between types of staff and stakeholders of care; and person-centred care through a decolonial lens. To uproot inequity and create fairer and more respectful maternity care for women, birthing people and staff, it is vital that contemporary maternity institutions understand the decolonial perspective. This novel enquiry offers a scaffolding to undertake this process. Due to significant differences in colonial history between Western colonising powers, it is important to decolonise with respect to these different territories, histories and challenges.
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Affiliation(s)
| | - Nathan Robinson
- Present Address: UCL Medical School, University College London, 74 Huntley St, London, WC1E 6DE UK
| | | | - Sarah Wong
- Present Address: UCL Medical School, University College London, 74 Huntley St, London, WC1E 6DE UK
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Nayar V. Levelling up medical education: getting comfortable with being uncomfortable. Br J Gen Pract 2022; 72:560-561. [PMID: 36424151 PMCID: PMC9710806 DOI: 10.3399/bjgp22x721217] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Affiliation(s)
- Vijay Nayar
- Primary Care Lead for Differential Attainment, Health Education England, Cambridge
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Fernandez MDS, Pontes AFL, Casarin M, Feijo JDS, Pola NM, Muniz FWMG. Factors associated with poor academic performance among undergraduate dental students: A cross‐sectional study. J Dent Educ 2022; 87:514-522. [PMID: 36349686 DOI: 10.1002/jdd.13134] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2022] [Revised: 08/06/2022] [Accepted: 10/16/2022] [Indexed: 11/11/2022]
Abstract
OBJECTIVE To evaluate the factors associated with poor academic performance among undergraduate dental students enrolled at a public university in Brazil. METHODS A semi-structured questionnaire addressing the exploratory variables of interest (sociodemographic and economic characteristics, use of medications and drugs, dentistry as the first choice of undergraduate course, and the Pittsburgh Sleep Quality Index) was hosted on Google Forms and shared with all dental students at the Federal University of Pelotas. Academic performance was evaluated based on institutional records, access to which the participants had previously authorized; students with good (average ≥7.0 points) or poor academic performance (average <7.0 points) were considered. Adjusted logistic regressions were performed to verify the association between academic performance and the exploratory variables (p < 0.05). RESULTS In total, 244 students were included, of whom 18.8% had poor academic performance. Increased age (OR: 1.34; 95%CI: 1.18-1.52), non-white skin color (OR: 1.34; 95%CI: 1.18-1.52), the use of medications for anxiety and depression (OR: 1.34; 95%CI: 1.18-1.52), and poor sleep quality (OR: 1.34; 95%CI: 1.18-1.52) were factors associated with poor academic performance. CONCLUSION A low prevalence of poor academic performance was observed. Non-white skin color, increased age, use of anxiolytics or antidepressants, and poor or disturbed sleep may reduce dental students' academic performance.
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Affiliation(s)
| | | | - Maísa Casarin
- Department of Periodontology Federal University of Pelotas Pelotas Rio Grande do Sul Brazil
| | | | - Natália Marcumini Pola
- Department of Periodontology Federal University of Pelotas Pelotas Rio Grande do Sul Brazil
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Sam AH, Fung CY, Reed M, Hughes E, Meeran K. Time for preference-informed foundation allocation? Clin Med (Lond) 2022; 22:590-593. [PMID: 38589169 PMCID: PMC9761417 DOI: 10.7861/clinmed.2022-0198] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
Successful completion of year 1 of the UK Foundation Programme is a General Medical Council requirement that newly qualified doctors must achieve in order to gain full registration for licence to practise in the UK. We present compelling evidence that both sections of the UK Foundation Programme allocation process, consisting of the Educational Performance Measure and Situational Judgement Test scores, are not fit for purpose. The ranking process drives competitive behaviours among medical students and undermines NHS teamworking values. Furthermore, data from 2013-2020 show that UK minority ethnic students consistently receive significantly lower SJT scores than White students. The current process in the UK allocates lower ranked students, who often need more academic and social support, to undersubscribed regions. This can lead to vacancies in less popular regions, ultimately worsening health inequality. A preference-informed allocation process will improve trainee access to support and help retain trainees in underserved regions. We aim to summarise the flaws of the current system and report a potential radical solution.
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Affiliation(s)
- Amir H Sam
- Imperial College London School of Medicine, London, UK.
| | | | - Malcolm Reed
- Brighton and Sussex Medical School, Brighton, UK
| | | | - Karim Meeran
- Imperial College London School of Medicine, London, UK
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Yeung EYH. Prejudice against international medical graduates. BMJ 2022; 379:o2445. [PMID: 36229062 DOI: 10.1136/bmj.o2445] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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Menezes A, Henry S, Agarwal G. It's high time Canada started collecting race-based performance data on medical training and careers. LANCET REGIONAL HEALTH. AMERICAS 2022; 14:100326. [PMID: 36777392 PMCID: PMC9904144 DOI: 10.1016/j.lana.2022.100326] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Affiliation(s)
- Anjali Menezes
- Differential Attainment REsearch Group (DARe), Assistant Clinical Professor (Adjunct), Department of Family Medicine, McMaster University, Hamilton, Canada
| | - Shayna Henry
- Differential Attainment REsearch Group (DARe), Assistant Clinical Professor (Adjunct), Department of Family Medicine, McMaster University, Hamilton, Canada
| | - Gina Agarwal
- Differential Attainment REsearch Group (DARe), Professor, McMaster Family Medicine Levitt Scholar, Department of Family Medicine, McMaster University, Hamilton, Canada
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Decolonisation of curricula in undergraduate dental education: an exploratory study. Br Dent J 2022; 233:415-422. [PMID: 36085477 PMCID: PMC9461393 DOI: 10.1038/s41415-022-4923-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2022] [Accepted: 05/23/2022] [Indexed: 11/17/2022]
Abstract
Aims To explore experiences and perceptions of students and staff regarding decolonisation of the curriculum in a dental undergraduate programme. Methods Participants were invited to respond to an online survey on decolonisation of the dental curriculum. The target population included current students on the Bachelor of Dental Surgery and Bachelor of Dental Therapy and Hygiene programmes, as well as dental staff at a university in the South West region of England. The common items for student and staff versions of the survey were focused on six themes: representation; content; peer engagement; assessment; language and communication; and culture. All responses were anonymous. Data on programme, year of study, age, sex and ethnicity were captured on a voluntary basis. Results In total, 34 staff members and 120 students from two different programmes participated in the survey, yielding a response rate of 87.17% for staff and 45.28% for students. A comparison showed that average student responses were lower compared with average staff responses. Of the 24 survey items, 17 showed significantly lower scores reported by minority ethnic (ME) students. ME students were, when compared with white counterparts, less likely to report that their programme included opportunities for group discussions about ethnicity and privilege. Similar comparisons of staff responses did not show significant differences between white and ME staff. Nevertheless, responses by staff and students across the board highlighted the need for further steps to improve the representation of ME groups in the curriculum. Conclusions This study provides useful insights into the perceptions and experiences of students and staff regarding the decolonisation of the dental curriculum in an undergraduate dental programme. Responses by the participants across the board identified several areas which could benefit from better representation of ME groups. Significant differences were noted between staff and student scores and also between white and ME students, indicating the latter group demonstrated more awareness regarding issues of representation. The findings underscore the need to take further steps to decolonise dental curricula. Explains the rationale for the decolonisation of educational curricula in higher education. Reports perceptions and experiences of students and staff regarding decolonisation of the dental curriculum at a British university. Underscores the need for further actions to encourage better representation of minority ethnic groups in dental education.
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Vinnicombe Z, Little M, Super J, Anakwe R. Differential attainment, socioeconomic factors and surgical training. Ann R Coll Surg Engl 2022; 104:577-582. [PMID: 35950509 PMCID: PMC9433186 DOI: 10.1308/rcsann.2021.0255] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/28/2021] [Indexed: 09/03/2023] Open
Abstract
INTRODUCTION Differential attainment (DA) is the gap in levels of achievement between different groups; socioeconomic factors are thought to play a significant role in DA. The aim of this study was to review and assess the evidence for DA in early surgical training and to examine the potential influence of socioeconomic status. METHODS Data were obtained from the General Medical Council GMC for those taking Membership of the Royal College of Surgeons (MRCS) examinations between 2016 and 2019 and core surgical training annual review of competency progression (ARCP) outcomes between 2017 and 2019. The index of multiple deprivation (IMD) was used as a measure of socioeconomic background. Trainees were then divided into deprivation quintiles (DQ1=most deprived, DQ5=least deprived). MRCS and ARCP outcomes were compared between DQ groups using 95% confidence intervals and chi-square tests. RESULTS Those from lower socioeconomic backgrounds had significantly lower overall MRCS pass rates (DQ1=45.5%, DQ2=48.9% vs DQ4=59.6%, DQ5=61.5%, p<0.05) and 1st time pass rates (DQ1&2=46.6% vs DQ4&5=63.5%, p<0.001). Additionally, they had a significantly higher number of attempts required to pass MRCS (DQ 1&2=1.86 vs DQ 4&5=1.54, p<0.01). Those from lower socioeconomic backgrounds had a significantly greater proportion of unsatisfactory ARCP outcomes (DQ1&2=24.4% vs DQ 4&5=14.2%, p<0.05). CONCLUSIONS There is clear evidence of the influence of socioeconomic background on DA in early surgical training. However, the reasons for this are likely complex and more work is required to investigate this relationship.
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Affiliation(s)
| | | | - J Super
- Maidstone and Tunbridge Wells NHS Trust, UK
| | - R Anakwe
- Imperial College NHS Foundation Trust, UK
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32
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Klein R, Ufere NN, Schaeffer S, Julian KA, Rao SR, Koch J, Volerman A, Snyder ED, Thompson V, Ganguli I, Burnett-Bowie SAM, Palamara K. Association Between Resident Race and Ethnicity and Clinical Performance Assessment Scores in Graduate Medical Education. ACADEMIC MEDICINE : JOURNAL OF THE ASSOCIATION OF AMERICAN MEDICAL COLLEGES 2022; 97:1351-1359. [PMID: 35583954 PMCID: PMC9910786 DOI: 10.1097/acm.0000000000004743] [Citation(s) in RCA: 16] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/16/2023]
Abstract
PURPOSE To assess the association between internal medicine (IM) residents' race/ethnicity and clinical performance assessments. METHOD The authors conducted a cross-sectional analysis of clinical performance assessment scores at 6 U.S. IM residency programs from 2016 to 2017. Residents underrepresented in medicine (URiM) were identified using self-reported race/ethnicity. Standardized scores were calculated for Accreditation Council for Graduate Medical Education core competencies. Cross-classified mixed-effects regression assessed the association between race/ethnicity and competency scores, adjusting for rotation time of year and setting; resident gender, postgraduate year, and IM In-Training Examination percentile rank; and faculty gender, rank, and specialty. RESULTS Data included 3,600 evaluations by 605 faculty of 703 residents, including 94 (13.4%) URiM residents. Resident race/ethnicity was associated with competency scores, with lower scores for URiM residents (difference in adjusted standardized scores between URiM and non-URiM residents, mean [standard error]) in medical knowledge (-0.123 [0.05], P = .021), systems-based practice (-0.179 [0.05], P = .005), practice-based learning and improvement (-0.112 [0.05], P = .032), professionalism (-0.116 [0.06], P = .036), and interpersonal and communication skills (-0.113 [0.06], P = .044). Translating this to a 1 to 5 scale in 0.5 increments, URiM resident ratings were 0.07 to 0.12 points lower than non-URiM resident ratings in these 5 competencies. The interaction with faculty gender was notable in professionalism (difference between URiM and non-URiM for men faculty -0.199 [0.06] vs women faculty -0.014 [0.07], P = .01) with men more than women faculty rating URiM residents lower than non-URiM residents. Using the 1 to 5 scale, men faculty rated URiM residents 0.13 points lower than non-URiM residents in professionalism. CONCLUSIONS Resident race/ethnicity was associated with assessment scores to the disadvantage of URiM residents. This may reflect bias in faculty assessment, effects of a noninclusive learning environment, or structural inequities in assessment.
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Affiliation(s)
- Robin Klein
- R. Klein is associate professor, Department of Medicine, Division of General Internal Medicine, Emory University School of Medicine, Atlanta, Georgia
| | - Nneka N Ufere
- N.N. Ufere is instructor of medicine, Department of Medicine, Division of Gastroenterology, Massachusetts General Hospital, Boston, Massachusetts
| | - Sarah Schaeffer
- S. Schaeffer is associate professor, Department of Medicine, Division of Hospital Medicine, University of California, San Francisco, San Francisco, California
| | - Katherine A Julian
- K.A. Julian is professor, Department of Medicine, Division of General Internal Medicine, University of California, San Francisco, San Francisco, California
| | - Sowmya R Rao
- S.R. Rao is statistician, Department of Global Health, Boston University School of Public Health and Massachusetts General Hospital Biostatistics Center, Boston, Massachusetts
| | - Jennifer Koch
- J. Koch is professor, Department of Medicine, University of Louisville, Louisville, Kentucky
| | - Anna Volerman
- A. Volerman is associate professor, Departments of Medicine and Pediatrics, University of Chicago, Chicago, Illinois
| | - Erin D Snyder
- E.D. Snyder is professor, Department of Medicine, Division of General Internal Medicine, University of Alabama Birmingham School of Medicine, Birmingham, Alabama
| | - Vanessa Thompson
- V. Thompson is associate professor, Department of Medicine, Division of General Internal Medicine, University of California, San Francisco, San Francisco, California
| | - Ishani Ganguli
- I. Ganguli is assistant professor, Department of Medicine, Division of General Internal Medicine and Primary Care, Brigham and Women's Hospital, Boston, Massachusetts
| | - Sherri-Ann M Burnett-Bowie
- S.-A.M. Burnett-Bowie is assistant professor, Department of Medicine, Division of Endocrinology, Massachusetts General Hospital, Boston, Massachusetts
| | - Kerri Palamara
- K. Palamara is associate professor, Department of Medicine, Massachusetts General Hospital, Boston, Massachusetts
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Lee WC, Ong CY, Veeraraghavan MA, Teo DB, Oh VMS. Factors affecting PACES success rate–A Singapore experience. ELECTRONIC JOURNAL OF GENERAL MEDICINE 2022. [DOI: 10.29333/ejgm/12177] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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Harvey PR, Phillips C, Newbery N, Nagamoottoo D, Woolf K, Trudgill NJ. Ethnic differences in success at application for consultant posts among United Kingdom physicians from 2011 to 2019: a retrospective cross-sectional observational study. J R Soc Med 2022; 115:300-312. [PMID: 35357252 DOI: 10.1177/01410768221085691] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
OBJECTIVES To identify associations between success following application for consultant physician posts and demographic factors. DESIGN Logistic regression analysis of nationwide survey data. SETTING United Kingdom (UK) physicians with a recent certificate of completion of training (CCT). PARTICIPANTS All UK trainee physicians who received a CCT between 2010 and 2019 were surveyed. Respondents were excluded if they had not applied for a consultant post or if application data were incomplete. MAIN OUTCOME MEASURES The primary outcome measure was success over the entire consultant application process, i.e. shortlisted and offered the post following the first application. Secondary outcomes were: shortlisted following first application and offered a consultant post at first interview. RESULTS From 7037 CCT holders surveyed, 50.7% responded. While 1198 (59.7%) respondents were white, 760 (37.9%) were from minority ethnic groups and 50 (3.5%) were of unknown ethnicity. Primary medical qualification (PMQ) country was the UK in 75.3% (n = 1512). On multivariable logistic regression analysis the independent negative associations with success were: minority ethnicity (odds ratio [OR] 0.55, 95% confidence interval [CI] 0.43-0.71); p < 0.001) vs. white; PMQ from Europe (OR 0.47, 95% CI 0.28-0.79; p = 0.004) or Asia (OR 0.68, 95% CI 0.49-0.96; p = 0.027) vs. UK PMQ; year of CCT 2012 (OR 0.40, 95% CI 0.24-0.68; p = 0.001), 2013 (OR 0.39, 95% CI 0.23-0.65; p < 0.001), and 2014 (OR 0.26, 95% CI 0.15-0.43; p < 0.001) vs. 2019. Specialties associated with lower success rates included Cardiology, Endocrinology, Genitourinary medicine, Palliative care, Renal and Respiratory, compared to Acute medicine. CONCLUSIONS Minority ethnic group candidates for consultant physician posts had lower success rates compared to white candidates after correction for important variables including specialty, time from and country of PMQ. This finding requires further evaluation to identify the causes for this variation.
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Affiliation(s)
- P R Harvey
- The Royal Wolverhampton NHS Trust, Wolverhampton, WV10 0QP, UK
| | - C Phillips
- Medical Workforce Unit, Royal College of Physicians, London, NW1 4LE,UK
| | - N Newbery
- Medical Workforce Unit, Royal College of Physicians, London, NW1 4LE,UK
| | - D Nagamoottoo
- Medical Workforce Unit, Royal College of Physicians, London, NW1 4LE,UK
| | - K Woolf
- Research Department of Medical Education, University College London Medical School, London, WC1E 6BT, UK
| | - N J Trudgill
- Medical Workforce Unit, Royal College of Physicians, London, NW1 4LE,UK.,Sandwell and West Birmingham NHS Trust, West Bromwich, B71 4HJ, UK
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Neville P. When I say … everyday racism. MEDICAL EDUCATION 2022; 56:260-261. [PMID: 34545603 DOI: 10.1111/medu.14667] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/16/2021] [Revised: 09/03/2021] [Accepted: 09/16/2021] [Indexed: 06/13/2023]
Abstract
In this 'When I say …' article, the concept of everyday racism is defined and explained as a useful theoretical and methodological tool to evidence the numerous ways in which the climate of medical school can adversely impact the social and educational achievements of ethnic minority students.
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van Andel CEE, Born MP, van den Broek WW, Stegers‐Jager KM. Do norms unintentionally increase stereotypical expressions? A randomised controlled trial. MEDICAL EDUCATION 2022; 56:331-338. [PMID: 34894161 PMCID: PMC9304281 DOI: 10.1111/medu.14712] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 07/15/2021] [Revised: 11/30/2021] [Accepted: 12/08/2021] [Indexed: 06/14/2023]
Abstract
INTRODUCTION Implicit biases of health professionals could cause biased judgements. Many anti-bias interventions seem to be ineffective, and some even counterproductive. People tend to be compliant to standards describing what the majority of people finds or does, and this could cause people to think in a stereotype-consistent manner. This study examines whether descriptive social norms such as 'the majority of people have stereotypes' (majority message), as often stated in interventions, actually increase people's stereotypes. To examine the effect of descriptive social norms (Hypothesis 1) and the effect of individual perceptions and preferences (Hypothesis 2a and 2b) on stereotypical expressions towards medical students. METHODS First, we determined which ethic stereotypes regarding medical students prevail in Dutch medical education (N = 52). Next, two similar randomised controlled trials, both with teachers and students, were carried out (N = 158 and N = 123, respectively), one with an East Asian student picture (ethnic minority) and one with a native Dutch student picture (ethnic majority). Participants were randomly assigned to either a majority-message, minority-message or no-message condition, and rated the presented minority or majority picture on specific stereotypical features. Subsequently, participants described a typical day of that same student's life. These descriptions were rated for stereotypicality by two independent raters, who were blind for condition and stimulus. Inclusive work environment (IWC) and social dominance orientation (SDO) of participants were measured as indicators of individual perceptions and preferences. RESULTS Stereotypes were expressed towards both picture stimuli, yet message condition did not affect stereotypical expressions. SDO positively related to stereotypical expressions towards the East Asian student, whereas IWC positively related to stereotypical expressions towards the native Dutch student. CONCLUSION Interventions do not unintentionally increase stereotypes by communicating what the majority of people thinks or does. Individual perceptions and preferences are predictive of stereotypes, whereas descriptive social norms are not.
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Affiliation(s)
| | - Marise P. Born
- Department of PsychologyErasmus University RotterdamRotterdamThe Netherlands
- Optentia and Faculty of Economic and Management SciencesNorth‐West UniversityPotchefstroomSouth Africa
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Ellis R, Brennan PA, Lee AJ, Scrimgeour DS, Cleland J. Differential attainment at MRCS according to gender, ethnicity, age and socioeconomic factors: a retrospective cohort study. J R Soc Med 2022; 115:257-272. [PMID: 35171739 PMCID: PMC9234885 DOI: 10.1177/01410768221079018] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Objective A recent independent review on diversity and inclusivity highlighted concerns
that barriers to surgical career progression exist for some groups of
individuals and not others. Group-level differences in performance at the
Intercollegiate Membership of the Royal Colleges of Surgeons (MRCS)
examinations have been identified but are yet to be investigated. We aimed
to characterise the relationship between sociodemographic differences and
performance at MRCS. Design Retrospective cohort study. Setting Secondary care. Participants All UK MRCS candidates attempting Part A (n = 5780) and Part
B (n = 2600) between 2013 and 2019 with linked
sociodemographic data in the UK Medical Education Database (https://www.ukmed.ac.uk). Main outcome measures Chi-square tests established univariate associations with MRCS performance.
Multiple logistic regression identified independent predictors of success,
adjusted for medical school performance. Results Statistically significant differences in MRCS pass rates were found according
to gender, ethnicity, age, graduate status, educational background and
socioeconomic status (all p < 0.05). After adjusting for
prior academic attainment, being male (odds ratio [OR] 2.34, 95% confidence
interval [CI] 1.87–2.92) or a non-graduate (OR 1.98, 95% CI 1.44–2.74) were
independent predictors of MRCS Part A success and being a non-graduate (OR
1.77, 95% CI 1.15–2.71) and having attended a fee-paying school (OR 1.51,
95% CI 1.08–2.10) were independent predictors of Part B success. Black and
minority ethnic groups were significantly less likely to pass MRCS Part B at
their first attempt (OR 0.41, 95% CI 0.18–0.92 for Black candidates and OR
0.49, 95% CI 0.35–0.69 for Asian candidates) compared to White
candidates. Conclusions There is significant group-level differential attainment at MRCS, likely to
represent the accumulation of privilege and disadvantage experienced by
individuals throughout their education and training. Those leading surgical
education now have a responsibility to identify and address the causes of
these attainment differences.
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Affiliation(s)
- Ricky Ellis
- Institute of Applied Health Sciences, University of Aberdeen, Aberdeen, AB24 3FX, UK.,Urology Department, Nottingham University Hospitals, Nottingham, NG5 1PB, UK
| | - Peter A Brennan
- Department of Maxillo-Facial Surgery, Queen Alexandra Hospital, Portsmouth, PO6 3LY, UK
| | - Amanda J Lee
- Medical Statistics Team, Institute of Applied Health Sciences, University of Aberdeen, AB24 3FX, UK
| | - Duncan Sg Scrimgeour
- Institute of Applied Health Sciences, University of Aberdeen, Aberdeen, AB24 3FX, UK.,Department of Colorectal Surgery, Aberdeen Royal Infirmary, Aberdeen, AB25 2ZN, UK
| | - Jennifer Cleland
- Lee Kong Chian School of Medicine, Nanyang Technological University, 308232, Singapore
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van Andel CEE, Born MP, van den Broek WW, Stegers‐Jager KM. Student ethnicity predicts social learning experiences, self-regulatory focus and grades. MEDICAL EDUCATION 2022; 56:211-219. [PMID: 34543459 PMCID: PMC9293402 DOI: 10.1111/medu.14666] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/14/2021] [Revised: 09/03/2021] [Accepted: 09/14/2021] [Indexed: 06/03/2023]
Abstract
CONTEXT Ethnic minority students find that their ethnicity negatively affects the evaluation of their capacities and their feelings in medical school. This study tests whether ethnic minority and majority students differ in their 'self-regulatory focus' in clinical training, that is, their ways to approach goals, due to differences in social learning experiences. Self-regulatory focus consists of a promotion and prevention focus. People who are prone to stereotypes and unfair treatments are more likely to have a prevention focus and conceal certain identity aspects. The objectives of the study are to test whether ethnic minority students, as compared with ethnic majority students, are equally likely to have a promotion focus, but more likely to have a prevention focus in clinical training due to more negative social learning experiences (Hypothesis 1), and whether the relationship between student ethnicity and clinical evaluations can be explained by students' gender, social learning experiences, self-regulatory focus and impression management (Hypothesis 2). METHODS Survey and clinical evaluation data of 312 (71.2% female) clerks were collected and grouped into 215 ethnic majority (69.4%) and 95 ethnic minority students (30.6%). Students' social learning experiences were measured as perceptions of unfair treatment, trust in supervisors and social academic fit. Self-regulatory focus (general and work specific) and impression management were also measured. A parallel mediation model (Hypothesis 1) and hierarchical multiple regression analyses were used (Hypothesis 2). RESULTS Ethnic minority students had higher perceptions of unfair treatment and lower trust in their supervisors in clinical training. They were more prevention focused in clinical training, but this was not mediated by having more negative social learning experiences. Lower clinical evaluations for ethnic minority students were unexplained. Promotion focus in clinical training and trust in supervisors positively relate to clinical grades. CONCLUSION Student ethnicity predicts social learning experiences, self-regulatory focus and grades in clinical training. The hidden curriculum plausibly plays a role here.
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Affiliation(s)
| | - Marise P. Born
- Department of PsychologyErasmus University RotterdamRotterdamThe Netherlands
- Optentia and Faculty of Economic and Management SciencesNorth‐West UniversityPotchefstroomSouth Africa
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Abstract
Richard A Powell and colleagues set out the barriers and solutions to eliminating inequalities embedded in the UK health research system
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Affiliation(s)
- Richard Antony Powell
- Ethnicity and Health Unit, NIHR Applied Research Collaboration Northwest London, London, UK
- Department of Primary Care and Public Health, School of Public Health, Imperial College London, London, UK
| | - Chidi Njoku
- Ethnicity and Health Unit, NIHR Applied Research Collaboration Northwest London, London, UK
- Department of Primary Care and Public Health, School of Public Health, Imperial College London, London, UK
| | - Ramyia Elangovan
- Centre for Implementation Science, Health Service and Population Research Department, King's College London, London, UK
| | - Ganesh Sathyamoorthy
- Ethnicity and Health Unit, NIHR Applied Research Collaboration Northwest London, London, UK
- Department of Primary Care and Public Health, School of Public Health, Imperial College London, London, UK
| | - Josephine Ocloo
- Centre for Implementation Science, Health Service and Population Research Department, King's College London, London, UK
- NIHR Applied Research Collaboration South London at King's College Hospital NHS Foundation Trust, London, UK
| | - Sudhin Thayil
- Centre for Perinatal Neuroscience, Department of Brain Sciences, Faculty of Medicine, Imperial College London, London, UK
| | - Mala Rao
- Ethnicity and Health Unit, NIHR Applied Research Collaboration Northwest London, London, UK
- Department of Primary Care and Public Health, School of Public Health, Imperial College London, London, UK
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Ellis R, Brennan PA, Scrimgeour DSG, Lee AJ, Cleland J. Does performance at the intercollegiate Membership of the Royal Colleges of Surgeons (MRCS) examination vary according to UK medical school and course type? A retrospective cohort study. BMJ Open 2022; 12:e054616. [PMID: 34987044 PMCID: PMC8734024 DOI: 10.1136/bmjopen-2021-054616] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/19/2021] [Accepted: 12/02/2021] [Indexed: 12/03/2022] Open
Abstract
OBJECTIVES The knowledge, skills and behaviours required of new UK medical graduates are the same but how these are achieved differs given medical schools vary in their mission, curricula and pedagogy. Medical school differences seem to influence performance on postgraduate assessments. To date, the relationship between medical schools, course types and performance at the Membership of the Royal Colleges of Surgeons examination (MRCS) has not been investigated. Understanding this relationship is vital to achieving alignment across undergraduate and postgraduate training, learning and assessment values. DESIGN AND PARTICIPANTS A retrospective longitudinal cohort study of UK medical graduates who attempted MRCS Part A (n=9730) and MRCS Part B (n=4645) between 2007 and 2017, using individual-level linked sociodemographic and prior academic attainment data from the UK Medical Education Database. METHODS We studied MRCS performance across all UK medical schools and examined relationships between potential predictors and MRCS performance using χ2 analysis. Multivariate logistic regression models identified independent predictors of MRCS success at first attempt. RESULTS MRCS pass rates differed significantly between individual medical schools (p<0.001) but not after adjusting for prior A-Level performance. Candidates from courses other than those described as problem-based learning (PBL) were 53% more likely to pass MRCS Part A (OR 1.53 (95% CI 1.25 to 1.87) and 54% more likely to pass Part B (OR 1.54 (1.05 to 2.25)) at first attempt after adjusting for prior academic performance. Attending a Standard-Entry 5-year medicine programme, having no prior degree and attending a Russell Group university were independent predictors of MRCS success in regression models (p<0.05). CONCLUSIONS There are significant differences in MRCS performance between medical schools. However, this variation is largely due to individual factors such as academic ability, rather than medical school factors. This study also highlights group level attainment differences that warrant further investigation to ensure equity within medical training.
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Affiliation(s)
- Ricky Ellis
- University of Aberdeen Institute of Applied Health Sciences, Aberdeen, UK
- Urology Department, Nottingham University Hospitals NHS Trust, Nottingham, UK
| | - Peter A Brennan
- Department of Maxillo-Facial Surgery, Queen Alexandra Hospital, Portsmouth, UK
| | - Duncan S G Scrimgeour
- University of Aberdeen Institute of Applied Health Sciences, Aberdeen, UK
- Department of Colorectal Surgery, Aberdeen Royal Infirmary, Aberdeen, UK
| | - Amanda J Lee
- Medical Statistics Team, University of Aberdeen Institute of Applied Health Sciences, Aberdeen, UK
| | - Jennifer Cleland
- Medical Education Research and Scholarship Unit (MERSU), Lee Kong Chian School of Medicine, Singapore
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Fyfe M, Horsburgh J, Blitz J, Chiavaroli N, Kumar S, Cleland J. The do's, don'ts and don't knows of redressing differential attainment related to race/ethnicity in medical schools. PERSPECTIVES ON MEDICAL EDUCATION 2022; 11:1-14. [PMID: 34964930 PMCID: PMC8714874 DOI: 10.1007/s40037-021-00696-3] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/11/2021] [Revised: 11/07/2021] [Accepted: 11/09/2021] [Indexed: 05/21/2023]
Abstract
INTRODUCTION Systematic and structural inequities in power and privilege create differential attainment whereby differences in average levels of performance are observed between students from different socio-demographic groups. This paper reviews the international evidence on differential attainment related to ethnicity/race in medical school, drawing together the key messages from research to date to provide guidance for educators to operationalize and enact change and identify areas for further research. METHODS Authors first identified areas of conceptual importance within differential attainment (learning, assessment, and systems/institutional factors) which were then the focus of a targeted review of the literature on differential attainment related to ethnicity/race in medical education and, where available and relevant, literature from higher education more generally. Each author then conducted a review of the literature and proposed guidelines based on their experience and research literature. The guidelines were iteratively reviewed and refined between all authors until we reached consensus on the Do's, Don'ts and Don't Knows. RESULTS We present 13 guidelines with a summary of the research evidence for each. Guidelines address assessment practices (assessment design, assessment formats, use of assessments and post-hoc analysis) and educational systems and cultures (student experience, learning environment, faculty diversity and diversity practices). CONCLUSIONS Differential attainment related to ethnicity/race is a complex, systemic problem reflective of unequal norms and practices within broader society and evident throughout assessment practices, the learning environment and student experiences at medical school. Currently, the strongest empirical evidence is around assessment processes themselves. There is emerging evidence of minoritized students facing discrimination and having different learning experiences in medical school, but more studies are needed. There is a pressing need for research on how to effectively redress systemic issues within our medical schools, particularly related to inequity in teaching and learning.
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Affiliation(s)
- Molly Fyfe
- Medical Education Innovation and Research Centre, Imperial College London, London, UK
| | - Jo Horsburgh
- Medical Education Innovation and Research Centre, Imperial College London, London, UK
- Centre for Higher Education Research and Scholarship, Imperial College London, London, UK
| | - Julia Blitz
- Centre for Health Professions Education, Faculty of Medicine and Health Sciences, Stellenbosch University, Stellenbosch, South Africa
| | | | - Sonia Kumar
- Medical Education Innovation and Research Centre, Imperial College London, London, UK
| | - Jennifer Cleland
- Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore, Singapore.
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Hope C, Humes D, Griffiths G, Lund J. Personal Characteristics Associated with Progression in Trauma and Orthopaedic Specialty Training: A Longitudinal Cohort Study. JOURNAL OF SURGICAL EDUCATION 2022; 79:253-259. [PMID: 34326034 DOI: 10.1016/j.jsurg.2021.06.027] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/20/2020] [Revised: 03/22/2021] [Accepted: 06/30/2021] [Indexed: 06/13/2023]
Abstract
AIM To identify demographic factors, including protected characteristics, and training specific factors which predict a nonstandard Annual Review of Competency Progression (ARCP) outcome during Trauma and Orthopedic Specialty training in the United Kingdom (UK). METHOD A longitudinal cohort study using data from UKMED was performed. ARCP outcome was the primary outcome measure. Multilevel univariate and multiple ordinal regression analyses were performed using STATA v 15. RESULTS Two thousand five hundred and ten Trauma and Orthopedic surgery trainees (ST3-ST8) with an ARCP outcome between 2010 and 2017 were included, comprising 11,011 ARCP outcomes. Eighty five percent (2130/2510) of trainees were male. Eighty two percent of outcomes were satisfactory. Female trainees had a 26% increased risk of nonstandard outcome (OR 1.26 95% CI 1.10-1.44) after adjusting for other factors. Older age at ARCP was associated with an increased risk of nonstandard ARCP outcome (OR 1.04 95% CI 1.03-1.06). International medical graduates had a 34% decreased risk of nonstandard outcome compared to UK graduates (OR 0.66 95% CI 0.54-0.81). Less than full time training was not associated with risk of a nonstandard ARCP outcome (OR 0.92 95% CI 0.76-1.12). CONCLUSION Female sex and older age at ARCP were significantly associated with nonstandard ARCP outcomes in Trauma and Orthopedic surgery, while international medical graduation was protective.
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Affiliation(s)
- Carla Hope
- Division of Medical Sciences and Graduate Entry Medicine, University of Nottingham, Royal Derby Hospital, Derby, United Kingdom.
| | - David Humes
- National Institute for Health Research Nottingham Digestive Diseases Biomedical Research Unit, QMC Campus, Nottingham University Hospitals NHS Trust, Nottingham, United Kingdom; Division of Epidemiology and Public Health, School of Medicine, University of Nottingham, Nottingham, United Kingdom; Nottingham Digestive Diseases Centre, School of Medicine, University of Nottingham, Nottingham, United Kingdom
| | | | - Jonathan Lund
- Division of Medical Sciences and Graduate Entry Medicine, University of Nottingham, Royal Derby Hospital, Derby, United Kingdom
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Foong LH. Anti-racism in the emergency department: Navigating clinician experiences of racism. Emerg Med Australas 2021; 34:116-119. [PMID: 34965613 DOI: 10.1111/1742-6723.13916] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2021] [Accepted: 12/08/2021] [Indexed: 11/30/2022]
Affiliation(s)
- Lai Heng Foong
- Emergency Department, Bankstown Lidcombe Hospital, Sydney, New South Wales, Australia
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Curtis S, Mozley H, Langford C, Hartland J, Kelly J. Challenging the deficit discourse in medical schools through reverse mentoring-using discourse analysis to explore staff perceptions of under-represented medical students. BMJ Open 2021; 11:e054890. [PMID: 34952883 PMCID: PMC9066338 DOI: 10.1136/bmjopen-2021-054890] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
INTRODUCTION Despite the increasing diversity of UK medical students, students from low-socioeconomic backgrounds, some minority groups and members of communities with protected identities remain under-represented in medicine. In trying to ascertain why this under-representation persists, literature focuses on the barriers and challenges faced by under-represented students as opposed to the institution's responsibility to remove or mitigate these obstacles. One UK University created a reverse mentoring scheme enabling students to mentor senior members of the medical faculty to help them understand the perspectives and experiences of students from minority backgrounds. This paper explores whether changes in staff perceptions of under-represented students resulted from engaging with reverse mentoring. METHODS This qualitative study explored the impact of the reverse mentoring scheme. Staff mentees were required to write a narrative text about the Higher Education journey of an under-represented medical student before and after the reverse mentoring intervention. These texts were compared using discourse analysis to identify shifts in language use that demonstrated a change in perceptions. RESULTS The key themes from five senior staff members indicate a positive change in staff characterisation of the students and an acceptance of institutional responsibility for challenges faced. Initial texts revealed a superficial understanding of the student journey that focused on individual deficit but had fairy tale endings depicting the medical school as benevolent. The follow-up texts revealed a deeper understanding reflected by the portrayal of students as capable agents and containing pragmatic endings acknowledging the responsibility of the medical school. CONCLUSION These findings highlight how removed senior staff can be from the reality of the student experience and that engaging with reverse mentoring helps to raise awareness and challenges the students face. This suggests a route for constructive change in medical schools and endorses the benefits of facilitating open discussion around educational inequity.
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Affiliation(s)
- Sally Curtis
- Primary Care, Population Sciences and Medical Education, Faculty of Medicine, University of Southampton, Southampton, Hampshire, UK
| | - Heather Mozley
- Primary Care, Population Sciences and Medical Education, Faculty of Medicine, University of Southampton, Southampton, Hampshire, UK
| | - Chloe Langford
- Primary Care, Population Sciences and Medical Education, Faculty of Medicine, University of Southampton, Southampton, Hampshire, UK
| | | | - Jacquie Kelly
- Primary Care, Population Sciences and Medical Education, Faculty of Medicine, University of Southampton, Southampton, Hampshire, UK
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Camm CF, Joshi A, Moore A, Sinclair HC, Westwood M, Greenwood JP, Calver A, Ray S, Allen C. Bullying in UK cardiology: a systemic problem requiring systemic solutions. Heart 2021; 108:212-218. [PMID: 34872975 DOI: 10.1136/heartjnl-2021-319882] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/21/2021] [Accepted: 09/24/2021] [Indexed: 11/04/2022] Open
Abstract
OBJECTIVES Bullying of trainee doctors has been shown to be associated with detrimental outcomes for both doctors and patients. However, there is limited evidence regarding the level of bullying of trainees within medical specialties. METHODS An annual survey of UK cardiology trainees was conducted through the British Junior Cardiologists' Association between 2017 and 2020 and asked questions about experiencing and witnessing bullying, and exposure to inappropriate language/behaviour in cardiology departments. Fisher's exact tests and univariable logistic regression models were used to describe associations between trainee characteristics, and reports of bullying and inappropriate language/behaviour. RESULTS Of 1358 trainees, bullying was reported by 152 (11%). Women had 55% higher odds of reporting being bullied (OR: 1.55 95% CI (1.08 to 2.21)). Non-UK medical school graduates were substantially more likely to be bullied (European Economic Area (EEA) OR: 2.22 (1.31 to 3.76), non-EEA/UK OR: 3.16 (2.13 to 4.68)) compared with those graduating from UK-based medical schools. Women were more likely than men to report sexist language (14% vs 4%, p<0.001). Non-UK medical school graduates were more likely to experience racist language (UK 1.5%, EEA 6%, other locations 7%, p=0.006). One-third of trainees (33%) reported at least one inappropriate behaviour with 8% reporting being shouted at or targeted with spontaneous anger. Consultants in cardiology (82%) and other specialties (70%) were most commonly implicated by those reporting bullying. DISCUSSION Bullying and inappropriate language are commonly experienced by cardiology trainees and disproportionately affect women and those who attended non-UK medical schools. Consultants both in cardiology and other specialties are the most commonly reported perpetrators.
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Affiliation(s)
- Christian Fielder Camm
- Keble College, Oxford University, Oxford, UK .,Department of Cardiology, Royal Berkshire NHS Foundation Trust, Reading, UK.,British Junior Cardiologists Association, London, UK
| | - Abhishek Joshi
- Cardiology Department, Barts Health NHS Trust, London, UK
| | - Abigail Moore
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
| | - Hannah C Sinclair
- Cardiology Department, University Hospital Southampton NHS Foundation Trust, Southampton, UK
| | - Mark Westwood
- Bart's Heart Centre, St Bartholomew's Hospital, London, UK.,Vice-Chair, Cardiology Specialist Advisory Committee, London, UK
| | - John Pierre Greenwood
- Cardiology Department, Leeds General Infirmary, Leeds, UK.,Leeds Institute of Cardiovascular and Metabolic Medicine, University of Leeds, Leeds, UK.,President, British Cardiovascular Society, London, UK
| | - Alison Calver
- Cardiology Department, University Hospital Southampton NHS Foundation Trust, Southampton, UK.,Chair, Cardiology Specialist Advisory Committee, London, UK
| | - Simon Ray
- Immediate Past-President, British Cardiovascular Society, London, UK.,Cardiology Department, Manchester University Hospitals, Manchester, UK
| | - Christopher Allen
- Guy's & St Thomas' Hospital, King's College, Rayne Institute, London, UK.,British Junior Cardiologists' Association, London, UK
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Joseph OR, Flint SW, Raymond-Williams R, Awadzi R, Johnson J. Understanding Healthcare Students' Experiences of Racial Bias: A Narrative Review of the Role of Implicit Bias and Potential Interventions in Educational Settings. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph182312771. [PMID: 34886495 PMCID: PMC8657581 DOI: 10.3390/ijerph182312771] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 10/14/2021] [Revised: 11/24/2021] [Accepted: 11/29/2021] [Indexed: 12/30/2022]
Abstract
Implicit racial bias is a persistent and pervasive challenge within healthcare education and training settings. A recent systematic review reported that 84% of included studies (31 out of 37) showed evidence of slight to strong pro-white or light skin tone bias amongst healthcare students and professionals. However, there remains a need to improve understanding about its impact on healthcare students and how they can be better supported. This narrative review provides an overview of current evidence regarding the role of implicit racial bias within healthcare education, considering trends, factors that contribute to bias, and possible interventions. Current evidence suggests that biases held by students remain consistent and may increase during healthcare education. Sources that contribute to the formation and maintenance of implicit racial bias include peers, educators, the curriculum, and placements within healthcare settings. Experiences of implicit racial bias can lead to psychosomatic symptoms, high attrition rates, and reduced diversity within the healthcare workforce. Interventions to address implicit racial bias include an organizational commitment to reducing bias in hiring, retention, and promotion processes, and by addressing misrepresentation of race in the curriculum. We conclude that future research should identify, discuss, and critically reflect on how implicit racial biases are enacted and sustained through the hidden curriculum and can have detrimental consequences for racial and ethnic minority healthcare students.
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Affiliation(s)
- Olivia Rochelle Joseph
- School of Psychology, University of Leeds, Leeds LS2 9JU, UK; (S.W.F.); (J.J.)
- Bradford Institute for Health Research, Bradford Royal Infirmary, Temple Bank House, Duckworth Lane, Bradford BD9 6RJ, UK
- Correspondence:
| | - Stuart W. Flint
- School of Psychology, University of Leeds, Leeds LS2 9JU, UK; (S.W.F.); (J.J.)
- Scaled Insights, Nexus, University of Leeds, Leeds LS2 3AA, UK
| | | | - Rossby Awadzi
- Postgraduate Graduate Medical Education, Northwick Park Hospital, London HA1 3UJ, UK;
| | - Judith Johnson
- School of Psychology, University of Leeds, Leeds LS2 9JU, UK; (S.W.F.); (J.J.)
- Bradford Institute for Health Research, Bradford Royal Infirmary, Temple Bank House, Duckworth Lane, Bradford BD9 6RJ, UK
- School of Public Health and Community Medicine, University of New South Wales, Sydney 2052, Australia
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Lagunes-Cordoba E, Maitra R, Dave S, Matheiken S, Oyebode F, O'Hara J, Tracy DK. International medical graduates: how can UK psychiatry do better? BJPsych Bull 2021; 45:299-304. [PMID: 33263275 PMCID: PMC8477154 DOI: 10.1192/bjb.2020.118] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
The National Health Service (NHS) was created 70 years ago to provide universal healthcare to the UK, and over the years it has relied upon international medical graduates (IMGs) to be able to meet its needs. Despite the benefits these professionals bring to the NHS, they often face barriers that hinder their well-being and performance. In this editorial, we discuss some of the most common challenges and the adverse effects these have on IMGs' lives and careers. However, we also propose practical measures to improve IMGs' experiences of working in psychiatry.
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Affiliation(s)
| | - Raka Maitra
- Tavistock and Portman NHS Foundation Trust, UK
| | - Subodh Dave
- Derbyshire Healthcare NHS Foundation Trust, UK
| | | | | | - Jean O'Hara
- South London and Maudsley NHS Foundation Trust, UK
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Isik U, Wouters A, Verdonk P, Croiset G, Kusurkar RA. "As an ethnic minority, you just have to work twice as hard." Experiences and motivation of ethnic minority students in medical education. PERSPECTIVES ON MEDICAL EDUCATION 2021; 10:272-278. [PMID: 34515955 PMCID: PMC8505584 DOI: 10.1007/s40037-021-00679-4] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/27/2020] [Revised: 06/30/2021] [Accepted: 07/01/2021] [Indexed: 06/09/2023]
Abstract
INTRODUCTION Adequate representation of ethnic minority groups in the medical workforce is crucial for ensuring equitable healthcare to diverse patient groups. This requires recruiting ethnic minority medical students and taking measures that enable them to complete their medical studies successfully. Grounded in self-determination theory and intersectionality, this paper explores the experiences of ethnic minority medical students across intersections with gender and other categories of difference and how these relate to students' motivation. METHODS An explorative, qualitative study was designed. Six focus groups were conducted with 26 ethnic minority students between December 2016 and May 2017. Thematic analysis was performed to identify, analyse and report themes within the data. RESULTS The findings were categorized into three main themes: the role of autonomy in the formation of motivation, including students' own study choice and the role of their family; interactions/'othering' in the learning environment, including feelings of not belonging; and intersection of ethnic minority background and gender with being 'the other', based on ethnicity. DISCUSSION Ethnic minority students generally do not have a prior medical network and need role models to whom they can relate. Ensuring or even appointing more ethnic minority role models throughout the medical educational continuum-for example, specialists from ethnic minorities in teaching and/or mentoring roles in the education-and making them more visible to students is recommended. Moreover, a culture needs to be created in the educational environment in which students and staff can discuss their ethnicity-related differences.
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Affiliation(s)
- Ulviye Isik
- Amsterdam UMC, Research in Education, Faculty of Medicine, Vrije Universiteit, Amsterdam, The Netherlands.
- LEARN! Research Institute for Learning and Education, Faculty of Psychology and Education, VU University Amsterdam, Amsterdam, The Netherlands.
| | - Anouk Wouters
- Amsterdam UMC, Research in Education, Faculty of Medicine, Vrije Universiteit, Amsterdam, The Netherlands
- LEARN! Research Institute for Learning and Education, Faculty of Psychology and Education, VU University Amsterdam, Amsterdam, The Netherlands
| | - Petra Verdonk
- Amsterdam UMC, Department of Ethics, Law & Humanities, Amsterdam Public Health Research Institute, Amsterdam, The Netherlands
| | - Gerda Croiset
- University Medical Center Groningen, Groningen, The Netherlands
| | - Rashmi A Kusurkar
- Amsterdam UMC, Research in Education, Faculty of Medicine, Vrije Universiteit, Amsterdam, The Netherlands
- LEARN! Research Institute for Learning and Education, Faculty of Psychology and Education, VU University Amsterdam, Amsterdam, The Netherlands
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Hope D, Dewar A, Hothersall EJ, Leach JP, Cameron I, Jaap A. Measuring differential attainment: a longitudinal analysis of assessment results for 1512 medical students at four Scottish medical schools. BMJ Open 2021; 11:e046056. [PMID: 34479932 PMCID: PMC8420706 DOI: 10.1136/bmjopen-2020-046056] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
OBJECTIVE To measure Differential Attainment (DA) among Scottish medical students and to explore whether attainment gaps increase or decrease during medical school. DESIGN A retrospective analysis of undergraduate medical student performance on written assessment, measured at the start and end of medical school. SETTING Four Scottish medical schools (universities of Aberdeen, Dundee, Edinburgh and Glasgow). PARTICIPANTS 1512 medical students who attempted (but did not necessarily pass) final written assessment. MAIN OUTCOME MEASURES The study modelled the change in attainment gap during medical school for four student demographical categories (white/non-white, international/Scottish domiciled, male/female and with/without a known disability) to test whether the attainment gap grew, shrank or remained stable during medical school. Separately, the study modelled the expected versus actual frequency of different demographical groups in the top and bottom decile of the cohort. RESULTS The attainment gap grew significantly for white versus non-white students (t(449.39)=7.37, p=0.001, d=0.49 and 95% CI 0.34 to 0.58), for internationally domiciled versus Scottish-domiciled students (t(205.8) = -7, p=0.01, d=0.61 and 95% CI -0.75 to -0.42) and for male versus female students (t(1336.68)=3.54, p=0.01, d=0.19 and 95% CI 0.08 to 0.27). International, non-white and male students received higher marks than their comparison group at the start of medical school but lower marks by final assessment. No significant differences were observed for disability status. Students with a known disability, Scottish students and non-white students were over-represented in the bottom decile and under-represented in the top decile. CONCLUSIONS The tendency for attainment gaps to grow during undergraduate medical education suggests that educational factors at medical schools may-however inadvertently-contribute to DA. It is of critical importance that medical schools investigate attainment gaps within their cohorts and explore potential underlying causes.
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Affiliation(s)
- David Hope
- Medical Education Unit, The University of Edinburgh College of Medicine and Veterinary Medicine, Edinburgh, UK
| | - Avril Dewar
- Medical Education Unit, The University of Edinburgh College of Medicine and Veterinary Medicine, Edinburgh, UK
| | | | - John Paul Leach
- School of Medicine, Dentistry, and Nursing, University of Glasgow, Glasgow, UK
| | - Isobel Cameron
- School of Medicine and Dentistry, University of Aberdeen, Aberdeen, UK
| | - Alan Jaap
- Medical Education Unit, The University of Edinburgh College of Medicine and Veterinary Medicine, Edinburgh, UK
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Krstić C, Krstić L, Tulloch A, Agius S, Warren A, Doody GA. The experience of widening participation students in undergraduate medical education in the UK: A qualitative systematic review. MEDICAL TEACHER 2021; 43:1044-1053. [PMID: 33861176 DOI: 10.1080/0142159x.2021.1908976] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Abstract
Introduction: Most widening participation (WP) research is focused on medical school recruitment; there is a paucity of research examining whether the experience of medical school itself is an equal experience for both 'traditional' and WP students.Methods: This qualitative systematic review used the Joanna Briggs Institute (JBI) meta-aggregative approach to characterise the experience of undergraduate medical education in the UK from the perspective of WP students. Seven databases were searched, 27 studies were critically appraised, and 208 findings were grouped into 12 categories and four synthesised findings.Results: The majority of the research found relates to ethnic minority groups, with reports of other WP groups being less frequent. Whilst WP programmes attempt to alleviate disadvantages prior to entering university, our findings suggest that difficulties follow WP students into medical school. Unfamiliarity with higher education and lack of representation of WP staff in faculty can deter help-seeking behaviour and result in lack of trust. Furthermore, students from different backgrounds can find their identity conflicted upon entering medical school. Despite difficulties in establishing social networks with 'traditional' medical student peers, WP students form strong relationships with students from similar backgrounds.Conclusions: Ultimately, these students find that the uniqueness of their experience is a useful tool for communicating with diverse patients which they come across and are able to overcome adversity with the help of a supportive institution.
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Affiliation(s)
- Courtney Krstić
- School of Medicine, University of Nottingham, Nottingham, UK
| | - Lazar Krstić
- School of Medicine, University of Nottingham, Nottingham, UK
| | - André Tulloch
- School of Medicine, University of Nottingham, Nottingham, UK
| | - Stevie Agius
- School of Medicine, University of Nottingham, Nottingham, UK
| | - Alistair Warren
- School of Medicine, University of Nottingham, Nottingham, UK
| | - Gillian A Doody
- School of Medicine, University of Nottingham, Nottingham, UK
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