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A randomised trial of the influence of racial stereotype bias on examiners' scores, feedback, and recollections in undergraduate clinical exams

Yeates, P; Woolf, KVM; Bennow, E; Davies, B; Boohan, M; Eva, K; (2017) A randomised trial of the influence of racial stereotype bias on examiners' scores, feedback, and recollections in undergraduate clinical exams. BMC Medicine , 15 , Article 179. 10.1186/s12916-017-0943-0. Green open access

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Abstract

BACKGROUND: Asian medical students and doctors receive lower scores on average than their white counterparts in examinations in the UK and internationally (a phenomenon known as “differential attainment”). This could be due to examiner bias or to social, psychological or cultural influences on learning or performance. We investigated whether students’ scores or feedback show influence of ethnicity-related bias; whether examiners unconsciously bring to mind (activate) stereotypes when judging Asian students’ performance; whether activation depends on the stereotypicality of students’ performances; and whether stereotypes influence examiner memories of performances. METHODS: This is a randomised, double-blinded, controlled, Internet-based trial. We created near-identical videos of medical student performances on a simulated Objective Structured Clinical Exam using British Asian and white British actors. Examiners were randomly assigned to watch performances from white and Asian students that were either consistent or inconsistent with a previously described stereotype of Asian students’ performance. We compared the two examiner groups in terms of the following: the scores and feedback they gave white and Asian students; how much the Asian stereotype was activated in their minds (response times to Asian-stereotypical vs neutral words in a lexical decision task); and whether the stereotype influenced memories of student performances (recognition rates for real vs invented stereotype-consistent vs stereotype-inconsistent phrases from one of the videos). RESULTS: Examiners responded to Asian-stereotypical words (716 ms, 95% confidence interval (CI) 702–731 ms) faster than neutral words (769 ms, 95% CI 753–786 ms, p < 0.001), suggesting Asian stereotypes were activated (or at least active) in examiners’ minds. This occurred regardless of whether examiners observed stereotype-consistent or stereotype-inconsistent performances. Despite this stereotype activation, student ethnicity had no influence on examiners’ scores; on the feedback examiners gave; or on examiners’ memories for one performance. CONCLUSIONS: Examiner bias does not appear to explain the differential attainment of Asian students in UK medical schools. Efforts to ensure equality should focus on social, psychological and cultural factors that may disadvantage learning or performance in Asian and other minority ethnic students.

Type: Article
Title: A randomised trial of the influence of racial stereotype bias on examiners' scores, feedback, and recollections in undergraduate clinical exams
Open access status: An open access version is available from UCL Discovery
DOI: 10.1186/s12916-017-0943-0
Publisher version: https://doi.org/10.1186/s12916-017-0943-0
Language: English
Additional information: This article is distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated.
UCL classification: UCL > Provost and Vice Provost Offices
UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences
UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences > Faculty of Medical Sciences
UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences > Faculty of Medical Sciences > UCL Medical School
URI: http://discovery.ucl.ac.uk/id/eprint/1574814
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