Educational Profiling Why are API students having difficulties in their clinical years of medical school?

The Disparity API students do fine as premeds and in their first two years of med school. API students do fine as premeds and in their first two years of med school. But they have difficulties during their clinical years (Xu et al. Acad Med 1994; 68:82). But they have difficulties during their clinical years (Xu et al. Acad Med 1994; 68:82).

A study of OSU students showed that API students Had fewer AOA (honor society) selections than would be expected statistically. Had fewer AOA (honor society) selections than would be expected statistically. Had a lower mean GPA than Caucasian students. Had a lower mean GPA than Caucasian students. Made up 44% of students failing pediatrics (7 of 16), which was 3 times higher than expected statistically. Made up 44% of students failing pediatrics (7 of 16), which was 3 times higher than expected statistically.

What’s going on? Part of it could be cultural- API students are brought up to behave in a certain manner, but (non Asian) attendings perceive those actions differently. Part of it could be cultural- API students are brought up to behave in a certain manner, but (non Asian) attendings perceive those actions differently.

Jane Lin-Fu (AAPIJH 2:295, 1994) studied differences in core values between Asians and Caucasians Asians Group-oriented Group-oriented Considerate of others Considerate of others Modest Modest Hierarchical Hierarchical Formal Formal Caucasians Individualistic Assertive Self-confident Egalitarian Informal

Asians are taught to: Be active listeners Be active listeners Develop consensus Develop consensus Not show off Not show off Not embarrass yourself Not embarrass yourself Have substance over style Have substance over style (courtesy B. Li) Caucasians are taught to: Be outspoken Take charge Stand out Learn by making mistakes Have style over substance (“no guts, no glory”)

How might these differences be perceived? (courtesy B. Li) Asian Behavior Quiet Quiet Modest Modest Formal Formal Asks few questions Asks few questions Respects the professor Respects the professor Anglo Perception Not assertive Doesn’t stand out Ill at ease Not inquisitive Not independent- thinking

Another hypothesis: API students could be lacking skills necessary in their clinical years: API students could be lacking skills necessary in their clinical years: Time management Time management Multitasking Multitasking Communication skills Communication skills Teamwork Teamwork Leadership Leadership Applied knowledge Applied knowledge Practical life skills Practical life skills (courtesy B. Li)

This deficit could be due to less time spent by Asian American students in Extracurricular activities Extracurricular activities Jobs Jobs Team sports Team sports Household Chores Household Chores Volunteering Volunteering (courtesy B. Li)

An OSU study showed that Asian American students spent significantly less time in extracurricular activities and jobs in high school and college than their white counterparts.

The study also showed that Asian parents gave significantly less advice to: The study also showed that Asian parents gave significantly less advice to: participate in extracurriculars participate in extracurriculars have part time/summer jobs have part time/summer jobs do household chores do household chores

Summary API students have less of the skills necessary during the clinical years due to less time spent in extracurriculars. API students have less of the skills necessary during the clinical years due to less time spent in extracurriculars. They are often perceived as being quiet and unassertive. They are often perceived as being quiet and unassertive.

This might lead to educational profiling of APIs as a whole. API students may be lumped together as “passive,” which mistranslates to being disinterested and lacking knowledge and competence.

How do we effect change? Attendings must be made aware of cultural influences and nuances. Attendings must be made aware of cultural influences and nuances. However, that will take a great deal of time and effort. However, that will take a great deal of time and effort. Until then, Asian American students have to play the clinical “game.” Until then, Asian American students have to play the clinical “game.”

The clinical “game” (courtesy B. Li) Be assertive, interactive, social, informal, and communicative. Be assertive, interactive, social, informal, and communicative. Don’t be afraid of making mistakes, asking for feedback, or asking about unwritten rules. Don’t be afraid of making mistakes, asking for feedback, or asking about unwritten rules. Develop organized work habits and learn to multitask. Develop organized work habits and learn to multitask. Use life experience to relate to patients. Use life experience to relate to patients. Style over substance (in certain cases). Style over substance (in certain cases).

What you can do prior to your clinical years: Seek activities outside of the classroom. Pursue other passions- they’ll help you develop broader skills. Seek activities outside of the classroom. Pursue other passions- they’ll help you develop broader skills. Practice your verbal skills- don’t be afraid to speak up in class! Practice your verbal skills- don’t be afraid to speak up in class!

On the wards: Find out about unwritten rules, and ask for feedback. Find out about unwritten rules, and ask for feedback. Speak- don’t just read from your notes. Speak- don’t just read from your notes. Practice your oral presentations. Practice your oral presentations. Prepare questions. Prepare questions. Organize, prioritize, and juggle tasks. Organize, prioritize, and juggle tasks. (courtesy B. Li)

Keep in mind… Because you’re playing the clinical game doesn’t mean you’re changing your “Asian-ness.” Because you’re playing the clinical game doesn’t mean you’re changing your “Asian-ness.” What you do in class and on the wards doesn’t change your core values. What you do in class and on the wards doesn’t change your core values.

Controversies You might be wondering: You might be wondering: Is there really this huge difference between Asians and Caucasians? Is there really this huge difference between Asians and Caucasians? What about the differences between Asian subgroups? What about the differences between Asian subgroups? Are these ideas just reinforcing stereotypes about Asians? Are these ideas just reinforcing stereotypes about Asians? More research definitely needs to be done in this area, but hopefully this has provoked questions in your mind. More research definitely needs to be done in this area, but hopefully this has provoked questions in your mind.