Why Do Ethnic Minority Students Under-Achieve Academically? MARK CARROLL ~ Senior Lecturer in Biochemistry JAMES MACKENZIE ~ Intercalated BSc student Barts and The London

Evidence for a general problem Ethnic minority students and graduates under-achieve academically in many areas of Medicine: ~ Predicting the ‘strugglers’ (Yates & James, 2006) ~ ‘Early performance’ predictors (Lumb & Vail, 2004) ~ Year 3 OSCE (Woolf et al., 2008) ~ Year 5 OSCE (Wass et al., 2003) ~ Year 5 written exams (McManus et al., 1996) ~ MRCP (UK) exams (Dewhurst et al., 2007) But there have been few studies of the early years of the MBBS course.

How to address the question? Study one cohort of MBBS students (2007 intake) at an early stage of the course (Years 1+2): 1.Statistical analysis of academic outcomes and related variables 2.Qualitative research with students On basis of self-declared ethnicity, categorised as ‘white’ or ‘non-white’.

Quantitative studies ~ variables studied Academic achievement at medical school: ~ Pass/Fail MBBS Part 1 (end of Year 1) ~ scores in end-of-year exam papers (coursework, EMQs, SAQs, practical/OSCE) Variables: ~ age~ sex~ ethnicity ~ highest qualification on entry (HQE) ~ UCAS tariff scores (A/AS levels); UKCAT scores (entrance test) ~ Home/EU or International ~ attendance (at PBL tutorials)

Quantitative studies ~ t-tests and correlations ~ Significant differences between ‘white’ (n = 92) and ‘non-white’ (n = 168) students with respect to: Age (white students older, p < 0.05) Verbal reasoning skills (white students better, p < 0.001) HQE (relatively more white graduates, p < 0.001) Performance in MBBS Part 1 exams (white students better in terms of fewer Fails and higher % scores, p < 0.001) ~ No differences with respect to: UCAS tariff scores; most UKCAT domain scores; attendance ~ Excluding International students does not affect outcomes

Quantitative studies ~ regression analysis Performance at MBBS Part 1: ~ Significant unique variables with respect to Pass/Fail end-of- Year 1 exams are: UCAS tariff scores and Ethnicity ~ Significant unique variables with respect to end-of-Year 1 % exam scores are: UCAS tariff scores (all papers); Ethnicity and HQE (some papers) ~ Other variables in the model do not make a significant unique contribution: UKCAT scores, sex, age, Home/International status ~ Model only accounts for 10~20% of total variance

Qualitative studies ~ questionnaire ~ Single paper-based question at end of tutorial; written responses; anonymous (n = 24) ~ Factors identified: family pressures (problems, commitments) work ethic (attitude, time management, independent study) distractions (peer group pressure, paid employment)

Qualitative studies ~ focus groups ~ Difficult to engage students from Asian ethnic backgrounds ~ 4 ethnically homogeneous focus groups (Asian, Black, White) (n = 14) ~ Emerging themes: motivation to study Medicine social transition work ethic time constraints educational transition peer pressure It’s like, ”I’m finally here”, and so they kind of just kick back a bit ~ female, Sri Lankan, focus group 4

Conclusions ~ Main significant unique variables contributing to academic success at MBBS Part 1 are: prior educational attainment (no surprise there!) ethnicity (‘white’ / ‘non-white’) ~ Multiple contributory factors to academic under-achievement by ‘non- white’ students in Year 1: family-related constraints time- and money-related constraints academic constraints (work ethic and study patterns) ~ Haven’t captured all significant contributory variables in this study

Further work? ~ Combine cohorts and repeat quantitative studies ~ Study ethnic sub-groups in combined cohorts ~ Include socio-economic background data and award of Merits ~ Extend ethnographic qualitative studies Acknowledgements: Viv Cook (BL) – qualitative analysis Kath Woolf (UCL) - multiple aspects

Any questions? Mark Carroll,