Theme
Student wellbeing
INSTITUTION
University of Sheffield
It has been previously reported that ethnic minority students academically underperform compared to their white counterparts. This project aimed to identify whether amongst medical students1-5, there is a relationship between ethnicity and the following factors: satisfaction with academic performance, sense of belonging and cultural influence.
An online questionnaire (quantitative and qualitative) was completed by 352 medical students from the University of Sheffield (70%; 246 students), Keele University (21%; 73 students) and London Universities (9%; 32 students). Ethnic distribution was 73.3% caucasian (258 students), 5.4% mixed race (19 students) and 21% ethnic minorities (EM)(74 students).
There are clear differences that exist between ethnicities in self-perceived satisfaction with academic performance, sense of belonging and insight into characteristics important for their student role. Further research should focus on better understanding of these differences, and their manifestations and developing appropriate interventions to optimise learning.
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Reasons for underperformance of EMs are multifactorial.
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Further investigation on the impact of stereotyping in the clinical learning/teaching contexts needs to be undertaken. This should lead to strategies that better support EM.
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Better awareness of the differences reported here may help EM medical students in developing positive strategies to improve integration and belonging in the medical school community.
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Dewhurst, N.G., McManus, C., Mollon, J., Dacre, J.E. and Vale, A.J. (2007) Performance in the MRCP (UK) Examination 2003 4: analysis of pass rates of UK graduates in relation to self-declared ethnicity and gender. BMC Medicine, 3(5), p.8.
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McManus, I.C., Richards, P., Winder, B.C. and Sproston, K.A. (1996) UK final examination performance of medical students from ethnic minorities. Medical Education, 30(3), p.195–200.
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Woolf, K., Cave, J., Greenhalgh, T., and Dacre, J. (2008) Ethnic stereotypes and the underachievement of UK medical students from ethnic minorities: qualitative study. British Medical Journal (Clinical research ed.), 337, p.611-614.
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Woolf, K., Haq, I., McManus, I., Higham, J. and Dacre, J. (2008) Exploring the underperformance of male and minority ethnic medical students in first year clinical examinations. Advances In Health Sciences Education, 13(5), p.607-616.
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Woolf, K., Potts, H.W.W. and McManus, I.C. (2011) Ethnicity and academic performance in UK trained doctors and medical students: systematic review and meta-analysis. British Medical Journal, 12(7797), p.342.
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Office for National Statistics, 2003 Ethnic group statistics: A guide for the collection and classification of ethnicity data London: HSMO. Available from: http://www.statistics.gov.uk/about/ethnic_group_statistics/ (accessed 2012/02/24)
ACADEMIC PERFORMANCE
EMs were more dissatisfied with their academic performance (p<0.001).
Quote 1 - EM student: "I sometimes feel I could perform better in certain areas."
SENSE OF BELONGING
EMs were less likely to feel they belonged to the medical community (p<0.05). Students measured sense of belonging using their relationships with other students and finding activities that met their interests within the medical school.
Quote 2 - Caucasian student: "I'm a medical student, I have friends who are medics and I go to some of their socials"
Quote 3 - EM student: "MEDSOC socials = booze most of the time, with a select group/clique on the forefront... Much more involved with the Union, where there is less prejudice and more tolerance towards ethnic minorities and international students! Med School isn't very good at realising that not everyone is the same and that some people take more time to adapt to a new environment/ new culture." (MEDSOC is the student unions medical society)
CULTURAL INFLUENCES
Behaviour
http://relivingmbadays.
With regards to an ideal medical student’s behavioural trait, caucasians were more likely to choose confidence (p<0.05). Regarding what main behavioural traits are emphasised during their upbringing, caucasians chose extraversion (p<0.05), mixed race students openness to experience (p<0.05) and EMs chose respectfulness (p<0.001).This reinforced the stereotyping cited in Woolf et al's research which may result in a negative impact on clinical experience/teaching for EMs whilst caucasions are positively impacted.3
Stereotyping
Participants believed the causes for variations in performance were an interplay between cultural influences, ethnic stereotyping, and communication skills.
Quote 5 - EM Student: "Stereotypes and discrimination by staff and patients affects clinical learning: 1. Quality of delivery and knowledge passed on. If you are a foreigner people suspect possible incompetence. So it feels you have to work twice as hard to achieve that same acknowledgement. 2. Family commitments especially extended family that others students do not seem to have.3. Learning slang and culture of the work place so you can fit in as much as possible."
Qoute 6 - EM Student: "As I wear a headscarf, I feel I have to make my dress more westernised in order to feel accepted and treated more fairly by patients and staff."
Quote 7 - EM Student: "Different opportunities may be given according to different ethnic background (it is not as serious as racism)."
Communication
Culture influenced behavioural traits and communication skills including the proficiency and accent of the spoken communication (English).
Quote 8 - EM Student: "The main barrier I feel is the language one which can impede understanding, shy to ask for help and put themselves forward, which may be a cultural thing or fear of embarassment."
Quote 9 - Caucasion Student: "I have a broad north eastern accent which has in the past been commented on by my peers and tutors, I therefore try and modify this in the medical environment. As people treat me as being unintelligent when I speak with my regional accent."
Quote 4 - Caucasion Student: "I think that there is definitely a confidence difference between those who have lived in the UK before university and those who have moved here only for university. As this course definitely requires a high confidence level, not only to be confident of your own academic performance amongst your peers but also from a social point of view, this may impact on academic performance. This lack of confidence can only be confounded by a reduced capacity for the English language - a real problem for the international students that should be a priority to be tackled by the university."
We would like thank all the participants for their valued contribution. We would like to thank Dr Lauren Brooks and Judith Rock (Keele University), Royal Society of Medicine, and the MDU Student section for disseminating our recruiting email.
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