The ethnicity attainment gap among medical and biomedical science students: a qualitative study

Inclusivity in health professional education: how can virtual simulation foster attitudes of inclusion?

Disparities in accessing quality healthcare persist among diverse populations. Health professional education should therefore promote more diversity in the health workforce, by fostering attitudes of inclusion. This paper outlines the potential of virtual simulation (VS), as one method in a system of health professional education, to promote inclusion and diversity. We conceptualise how VS can allow learners to experience an alternative to what HPE currently is by drawing on two social justice theorists, Paulo Freire, and Nancy Fraser and their ideas about 'voice' and 'representation'. We present two principles for VS design and implementation: (1) giving voice to learners has the power to transform; and (2) representation in VS builds inclusion. We provide practical means of building voice and representation into VS learning activities, followed by an example. Purposeful and thoughtful integration of these principles paves the way for a more diverse and inclusive healthcare workforce.

Exploring BAME Student Experiences in Healthcare Courses in the United Kingdom: A Systematic Review

Introduction

Black, Asian, and Minority Ethnic (BAME) students in healthcare-related courses are exposed to various challenging experiences compared to their White counterparts, not only in the UK (United Kingdom) but across the globe. Underachieving, stereotyping, racial bias, and cultural differences, among other experiences, hinder their medical education, practice, and attainment. This review aimed to explore and understand the experiences of BAME students enrolled in healthcare related courses in the United Kingdom.

Methods

Computerised bibliographic search was carried out using MeSH and free text descriptors via PubMed, Cochrane, Google Scholar, and Science Direct for eligible English-published studies exploring BAME experiences in the UK from 2010-2023.

Results

A cumulative total of 813 studies were obtained from the literature search, of which five met the inclusion criteria. Quality assessment for risk of bias was assessed using the Newcastle Ottawa scale, yielding one study of satisfactory quality, while four were deemed to be of good quality.

Conclusion

BAME students pursuing health-related courses across the UK. face a range of experiences, including racial discrimination, unconscious bias, and a lack of representation and support. Additionally, BAME students are more likely to report incidents of racial harassment and withdraw from their respective courses as well as experiencing mental health issues due to their experiences.

Is the awarding gap at UK medical schools influenced by ethnicity and medical school attended? A retrospective cohort study

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.

Discriminatory episodes negatively impact the quality of life of Brazilian dental students: A cross-sectional study

PURPOSE

This study aimed to evaluate whether discriminatory episodes occurring in the university environment were associated with dental students' self-perceived overall quality of life and assess the cumulative effect of perceived discriminatory experiences on the overall quality of life.

METHODS

In this cross-sectional study, all students enrolled in three Brazilian dental schools were invited to participate in a survey between August and October 2019. The outcome was students' self-perceived quality of life, measured through the overall quality of life item of the World Health Organization-Quality of Life Abbreviated Version (WHOQOL-BREF). Descriptive, bivariate, and multivariable logistic regression analyses (95% confidence intervals and α of 5%) were conducted using RStudio software.

RESULTS

The sample was composed of 732 students (70.2% response rate). The great part was female (66.9%), white or yellow skin color (67.9%), and were children of highly educated mothers. About 68% of the students reported having experienced at least one of the seven discriminatory experiences presented in the questionnaire and 18.1% reported neutral or negative quality of life. In multivariable analyses, it was estimated that students who experienced at least one episode of discrimination were 2.54 times (95% CI: 1.47-4.34) more likely to report worse quality of life than their counterparts who reported no experience of discrimination. There was also a 25% (95% CI: 1.10-1.42) increase in the odds of reporting poorer quality of life for each additional discriminatory experience reported.

CONCLUSION

Reporting at least one discriminatory situation in the academic environment was associated with worse quality of life among dental students, and a cumulative effect was also noted.

Authentic Pathology Specimen Reception: A Valuable Resource for Developing Biomedical Science Student Competencies and Employability

Background/Introduction: The pathology specimen reception is fundamental to the services provided by Biomedical Science laboratories worldwide. To ensure patient safety and that samples are of adequate quality to send for analysis, prospective Biomedical Scientists should have a robust knowledge of the processes involved and the acceptance criteria of the pathology specimen reception. This knowledge has been highlighted by employers as a current gap in Biomedical Science graduates and therefore needs to be addressed within higher education settings. To do this, this study aimed to 1) design a practical session to simulate the key processes of the pathology specimen reception and 2) to understand Biomedical Science students' opinions on these activities and the development of transferable skills required for post-graduate employment. Methods: The practical session was designed based on industrial requirements and academic knowledge of student skill sets to ensure suitability. Qualitative information regarding participant demographics and career interests was acquired through open-answer or multiple-choice questions. Quantitative student feedback was acquired via questionnaires utilising a 5-point Likert scale (n = 77). Results: The scenario-based practical session provided students with a positive learning experience with 98.7% of participants enjoying the session, with 87.0% stating they learned a lot by completing the session. It was also identified that participants preferred this style of learning to that of conventional higher education teaching modalities with 97.4% stating they would prefer simulated employment focussed scenarios embedded into the curriculum more often. The majority of participants also thought this session was helpful for the development of their key transferrable skills including teamworking, communication, and confidence. When stratified based on demographic data, there was minimal difference between cohorts and in the majority of cases, those participants from non-traditional university entry backgrounds had a more positive experience and better transferable skill development following the completion of this style of learning experience. Conclusion: This study highlights simulation-based learning as a tool to develop core Biomedical Science knowledge, build student graduate capital, and ensure the preparedness of students for post-graduation employment.

Exploring physiotherapy education in Australia from the perspective of Muslim women physiotherapy students

BACKGROUND

Despite Australia's multiculturalism, physiotherapists from minority ethnic groups, including Muslim women, may experience social exclusion in physiotherapy training based on research in other countries.

OBJECTIVE

Explore Muslim women's experiences of physiotherapy education in Australia and how these experiences could be improved (if needed).

METHODS

Qualitative research approach. Data were produced through semi-structured interviews and analyzed with reflexive thematic analysis.

RESULTS

Eleven participants were interviewed. Four main themes were produced: 1) omnipresent concerns about disrobing, physical proximity and touch in mixed-gender settings; 2) physiotherapy seen as a culturally inappropriate profession for Muslim women; 3) prevalence of an "Aussie" student environment; and 4) lack of systemic inclusivity. Suggestions to improve inclusivity, involved: systemically embedding measures such as alternatives for disrobing and proximity between genders; and promoting diverse social activities.

CONCLUSION

Results suggest Australian physiotherapy education lacks systemic cultural sensitivity for Muslim women. To reduce the burden for change being placed on Muslim women students, culturally responsive institutional protocols and staff training could be established.

The Benefits of Using Case Study Focussed, Problem Based Learning Approaches to Unit Design for Biomedical Science Students

As part of the Biomedical Sciences undergraduate degree course students are required to apply biological principles to the interpretation of clinical case studies and the diagnosis of patients. Case study-based learning, i.e., application of knowledge to patient diagnosis, is new to most students as case studies do not form part of non-applied A level courses in biological sciences. This approach is an example of Problem Based Learning (PBL) which has been shown to support higher levels of student learning, encouraging critical thinking and analysis. PBL approaches have also been shown to increase academic satisfaction and student engagement. In recent years we have observed a downwards trend in student engagement and historically student performance in applied case study-based assessments to be lower than that observed for assessments based on detailing fundamental biological principles. We hypothesised that PBL teaching delivery would support students in preparing for case study-based assessments, helping them to demonstrate their critical evaluation and problem-solving skills, and hence, improve student performance. We also hypothesised that the student learning experience would be enhanced by a PBL teaching delivery approach which would improve overall engagement. We therefore redesigned a second year Biomedical Sciences degree haematology and clinical biochemistry unit: "Blood Science," with a stronger focus on PBL, including case study focussed activities throughout the unit. We subsequently analysed whether this PBL-focussed unit design improved student experience and feedback, student engagement and student confidence for biomedical science undergraduate students. We present here, our teaching strategy and the impact our changes had on student feedback for the 21/22 and 22/23 academic years. Our findings demonstrate that case study-based activities and tutorial PBL exercises, when incorporated into the curriculum design, can improve student experience in the Biomedical Sciences and other biological science undergraduate degree courses.

Intersectional Identities: Making Sense of Skill Development on Clinical Placements

OBJECTIVE

Little is known about the influence of personal experiences on learners' trajectories toward mastery. Newell's theory of constraints articulates the relationship between environmental, individual, and task-related factors for skill development. This study explores how undergraduate pharmacy students experience skill development on placements and what the barriers and facilitators are within Newell's framework.

METHODS

Year 3 undergraduate pharmacy students were invited to take part in focus groups exploring Newell's theory relative to skill development. Verbatim transcripts were analyzed using an interpretive phenomenological approach.

RESULTS

Five focus groups were conducted with 16 students. The placement task provided structure through entrustable professional activities (EPAs). The resulting skill development varied but included EPA expected behaviors and also skills for mastery, eg, self-reflection. Students' personal identities acted as both barriers and facilitators. For example, expecting or experiencing racial microaggressions limited participation; having a local accent facilitated rapport with patients. Students worked toward integration into the community of practice (the ward), where the staff was critical to inclusion. Where students had barriers related to their identities, they found it more difficult to access the community of practice.

CONCLUSION

Factors related to the community of practice (environment), students' identities (individual), and the EPA behaviors (task) can influence skill development during placement. For some students, these factors will be more prevalent, and elements of their identities may intersect and conflict, acting as both barriers and facilitators to skill development. Educators can consider the influence of intersectionality on student identity when designing and preparing new placements and assessing students.

Ethnic minority GP trainees at risk for underperformance assessments: a quantitative cohort study

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.

Changing trends in ethnicity and academic performance: observational cohort data from a UK medical school

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.

Decolonisation of curricula in undergraduate dental education: an exploratory study

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.

Ethnicity-related stereotypes and their impacts on medical students: A critical narrative review of health professions education literature

BACKGROUND

Stereotypes are oversimplified beliefs about groups of people. Social psychology concepts and theories describing ethnicity-related stereotypes are well reported in non-medical educational settings. In contrast, the full impact of stereotyping on medical students, and the extent to which they were represented in health professions education (HPE) is less well-described. Using the lens of social psychological theory, this review aimed to describe ethnicity-related stereotypes about medical students portrayed in HPE literature and the impacts of those stereotypes.

METHODS

A critical narrative approach was undertaken. Social psychology concepts and theories were used as a framework through which to review the impacts of ethnicity-related stereotypes on medical students as described in HPE literature. A database search of Ovid MEDLINE, JSTOR, Project Muse, and PsychINFO was conducted to identify both theoretical and empirical articles relating to this topic in the HPE literature. Data was synthesised using thematic analysis, giving particular care to appraise the evidence from perspectives in social psychology.

FINDINGS

In HPE, the experiences and impact of stereotyping on learners from minority ethnic groups was explained by social psychology concepts such as stereotype threat, stereotype reactance, attributional ambiguity, self-fulfilling prophecy, stereotype boost, stereotype lift, and stereotype masking. Stereotype boost and stereotype lift were particularly described among students who identified as White, whereas stereotype threat was described more commonly among students from minority ethnics groups. The impact of stereotyping is not just on assessment, but may be across all teaching and learning activities at medical school.

INTERPRETATION

Social psychology concepts and theories can be used to describe the experience and impact of ethnicity-related stereotypes in HPE. Educators can better support learners from minority ethnic groups by self-reflecting over assumptions about individuals from minority ethnic groups, as well as minimise the impact of stereotyping and bias to create more inclusive learning environments.

Case study: Co-creating a flipped feed-in approach to a virtual biochemistry lab assessment: increasing student achievement and engagement in a large, diverse cohort

More inclusive, authentic assessments are required to address awarding gaps and to ensure that bioscience students can apply their knowledge to relevant work-based scenarios. In this case report, we present a co-created approach to designing a more inclusive, virtual biochemistry lab assessment for a diverse cohort of ∼270 first-year students. The assignment was to write up an inclusive clinical case study as a one-page journal article. A flipped classroom approach taught the relevant skills, along with simulated labs from Learning Science Ltd. Student Lecturers co-created the assessment, including the marking rubric and the unexemplars. We replaced traditional feedback with a flipped, feed-in approach where students were able to engage in a formative assessment with peer marking and unexemplars. Whilst the summative assessment was marked anonymously, a dialogue-based approach was employed, where students could request personalised audio feed-forward from the tutor. The high pass rate (97%) and student satisfaction score (88%) suggest that this approach is an effective way to challenge, engage and support a large, diverse cohort of students. First-year students who participated in the flipped feed-in experience obtained a significantly higher summative mark (56.7% cf. 50.9%) than those who did not. Interestingly, students in receipt of learning adjustments scored higher marks on average in the summative assessment (59.3% cf. 54.3%), suggesting that we have reversed the disability-based attainment gap. Further investigation into whether a co-created, flipped feed-in approach can reduce attainment gaps based on ethnicity, gender and age is warranted.

Cultural diversity and inclusion in UK medical schools

Background

Racially minoritised groups across the globe continue to experience differential outcomes in both health and education. Medical schools can play an instrumental role in addressing both these disparities, by creating inclusive student communities and ensuring that tomorrow's doctors can care for our increasingly diverse populations.

Objectives

This collaborative, qualitative study led by three United Kingdom (UK) institutions aimed to explore the perspectives of Heads of Primary Care Teaching (HOTs) on cultural diversity and inclusion across UK medical schools.

Methods

In December 2020, five focus groups were conducted remotely with 23 HOTs, or a nominated deputy. We explored participants' opinions regarding opportunities and barriers to cultural diversity and inclusion in medical education, ways to overcome these challenges and shared examples of best practice. Data were transcribed verbatim and thematically analysed by three researchers.

Results

Investigators identified six themes from the data: lack of faculty diversity, tokenistic faculty training, institutional mindset, diversifying the formal and hidden curricula, intersectionality and student voice.

Conclusion

Medical schools worldwide face similar challenges, uncertainties and opportunities when integrating diversity and inclusion throughout the learning environment. Although the importance of the topic is increasingly acknowledged, current efforts are viewed as being passive and tokenistic, hindered by challenges at multiple levels. Partnership with students and collaboration within and between institutions nationally and internationally will enable us to move forwards with both local and global positive, sustainable change.

The do's, don'ts and don't knows of redressing differential attainment related to race/ethnicity in medical schools

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.

Understanding Healthcare Students' Experiences of Racial Bias: A Narrative Review of the Role of Implicit Bias and Potential Interventions in Educational Settings

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.

Penn Access Summer Scholars program: a mixed method analysis of a virtual offering of a premedical diversity summer enrichment program

In the USA, numerous summer programs are available for undergraduate students that seek to increase the number of individuals from groups underrepresented in medicine (URM) that matriculate to medical school. These programs have typically been conducted at research-focused institutions, involving hands-on-research and various enrichment experiences. For 2020, the COVID-19 pandemic resulted in the suspension of on-campus student activities at American universities, necessitating a switch to a virtual format for these URM-focused programs. Outcomes, however, from these programs conducted virtually, necessitated by the COVID-19 pandemic, have not been reported. The Penn Access Summer Scholars (PASS) program at the Perelman School of Medicine (PSOM) targets URM undergraduates, providing two consecutive summers of mentored research and enrichment experiences, with the goal of enabling participants' matriculation to PSOM. PASS has been an 8 week on-campus experience, but during summer 2020, virtual programming of 6 weeks was provided due to the COVID-19 pandemic. Participants in the 2020 virtual offering of PASS completed pre- and post-program surveys that included 5-point Likert-style and open-ended questions to determine the impact of the programing on self-assessments of research skills, familiarity with the physician identity, and preparedness to be a PSOM student. Post-program, participants also assessed program administration and content. With respect to program objectives, participants reported significant increases in their self-reported confidence in conducting research, understanding of physician identity, and sense of preparedness for medical school. The educational value of the program content, their level of engagement in the program and the overall quality of the program were rated as excellent or outstanding by large majorities of respondents. Content analyses of participant comments were consistent with these quantitative results. Therefore, a premedical summer enrichment program targeting URM undergraduates can be successfully conducted virtually to achieve program objectives and may increase the availability to these initiatives.

Twelve tips for incorporating migrant and ethnic minorities in the medical curriculum and healthcare

Migrant and ethnic communities face several challenges within healthcare systems as patients, physicians and medical students. For health inequalities to be addressed, changes need to be made within our healthcare systems, starting from how the medical curriculum is taught to prospective clinicians. In this article, we present twelve ways to challenge the difficulties migrant and ethnic minorities face in healthcare by incorporating patient, physician and medical student factors into the medical school curriculum and healthcare, in a hope to change outcomes for our widely diverse population of patients and colleagues.

The experience of widening participation students in undergraduate medical education in the UK: A qualitative systematic review

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.

A quantitative study of race and gender representation within London medical school leadership

OBJECTIVES

To explore potential disparities in representation of Racially Minoritised (RM) persons and women in leadership roles in London Medical Schools compared to their RM and female student populations.

METHODS

General Medical Council's Medical School Annual Return 2017-18 data and official leadership team webpages were used to determine percentages of RM and female students and percentages of RM and women leaders in London medical schools. Student and leadership team percentages were then compared using chi-squared tests to assess statistically significant differences.

RESULTS

The percentage of RM persons filling leadership roles in London medical schools combined was statistically significantly less than the percentage of RM persons that compose the combined student body (8.6% (N=81) versus 60.2% (N=8786, χ²(1, N=8,867)=88.83, p<0.001). There was no statistically significant difference between the percentage of women filling leadership roles and the percentage of women in the combined student body (43.4% (N = 83) versus 52.5% (N=9026, χ²(1, N=9,109) =2.85, p=0.0913).

CONCLUSIONS

Results mirror the underrepresentation of RM persons in leadership positions throughout the National Health Service (NHS) and in higher education but reflect the improved representation of women in leadership positions seen at the NHS board level. Greater effort is necessary to rectify RM representation within London medical school leadership teams. This is especially imperative given that racially similar role models for RM students are an important predictor in determining academic and future success.

Addressing racial inequalities in dental education: decolonising the dental curricula

The aim of this paper is to highlight the impact of racial disparities on the educational experiences of Black and minority ethnic students in healthcare education. Attainment gaps and barriers to career progression for minority ethnic home students in the United Kingdom have been recognised for decades, but little progress has been made to address these issues. Students and staff in higher education have been campaigning for 'decolonisation of the curriculum' to improve inclusivity and representation. These trends are being mirrored in medical education and there is growing recognition to decolonise the medical curricula. This would improve the educational experience and attainment of minority ethnic students and doctors, and would also help to address disparities in healthcare provision for minority ethnic patients. The context for decolonisation of the dental curricula is provided, followed by a discussion on the benefits, challenges and strategies for such decolonisation.

The Evolution of Social Beliefs 1960-2016 in the United States and Its Influence on Empathy and Prosocial Expression in Medicine

This perspective surveys healthcare's response to the increased prominence of racial, ethnic, religious and sexual minorities as well as females in American culture. It argues for understanding physicians both as products of the broader society and its changes. Starting in the 1960s, empiric evidence for the rise of reactionary viewpoints in response to major social movements is outlined. Structural reasons for the prevalence of such ideologies within medicine are highlighted. Its negative consequences for minority health are addressed. Finally, the author turns to compensatory strategies to improve the social environment within healthcare. Alternative selection strategies for medical school are proposed, with a stronger focus on empathetic candidates.

Working hard to belong: a qualitative study exploring students from black, Asian and minority ethnic backgrounds experiences of pre-registration physiotherapy education

BACKGROUND

Previous research has demonstrated that attainment inequalities exist for students from Black Asian and Minority Ethnic (BAME) groups in pre-registration physiotherapy education. While previous research has explored students from BAME backgrounds experience of university, the context of physiotherapy is unique and is under researched. Therefore the purpose of this study was to explore BAME student experiences during their physiotherapy training.

METHODS

Using a phenomenological approach pre-registration BSc and MSc students from BAME backgrounds from two universities who had completed both academic and clinical modules were invited to participate. Focus groups followed a topic guide developed from the literature and were facilitated by physiotherapy educators from outside the host institution. They were digitally recorded, transcribed verbatim and analysed thematically. Analytical triangulation was adopted throughout the research process as a mechanism to enhance rigour.

RESULTS

Seventeen students participated from a range of self-identified BAME backgrounds that were also representative of age, gender and course. Themes derived from the data included: feeling an outsider in reflections of belonging, behaviours by others that marginalise BAME and personal strategies to integrate in physiotherapy despite the lack of power and influence. Collectively these themes demonstrate a range of challenges which students from BAME backgrounds face within both an academic and practice learning environment.

CONCLUSIONS

While this may not be surprising based on other disciplines, this study demonstrates that studying physiotherapy as a student from BAME background requires persistence to overcome a series of many implicit challenges. Understanding the experiences of students from BAME backgrounds presents unique opportunities to educate the profession and co-create opportunities for a more diverse profession with practitioners and educators as role models. There is a need for greater training for educators to listen to these students' voices and their stories, and understand where institutional structures and practices could be modified to enable BAME student inclusion in physiotherapy education and practice.