Ethnic disparities in undergraduate pre‐clinical and clinical performance

Stegers‐Jager, Karen M.; Steyerberg, Ewout W.; Cohen-Schotanus, Janke; Themmen, Axel P. N.

doi:10.1111/j.1365-2923.2012.04265.x

Cited by 53 publications

(79 citation statements)

References 33 publications

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“…Within clinical placements the judgement of educators has been studied with concerns over overt negative bias noted in both physiotherapy [12,13] and medicine [16,17]. Feelings of isolation and hostility in the academic environment have also been noted [9].…”

Section: Discussionmentioning

confidence: 99%

Does ethnicity, gender or age of physiotherapy students affect performance in the final clinical placements? An exploratory study

2014

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IntroductionSince 2003, widening participation in higher education has been a strategic objective of Higher Education Funding Council for England [1] supported by the Office For Fair Access [2].This agenda has particular relevance for professions such as physiotherapy, where lack of diversity has raised concerns resulting in some to call for the profession to more appropriately reflect the general population [3]. Indeed, some physiotherapists have suggested that the lack of diversity within the workforce is a barrier to both clinical practice and service provision [4].Physiotherapy has traditionally been a white, female profession [5,6] but this demographic is changing with the national profile of all students studying physiotherapy in the 2009/10 cohort reported as 30% male and 50% mature entrants [6,7]. 12% were from minority ethnic backgrounds [7], a leap from under 5% in 2005 [8].Increasing diversity of the profession is welcomed, but these changes do require Higher Education Institutions (HEI) to be vigilant towards ensuring the progression and success of students from all demographic profiles [9]. Whilst some reports question if increasing diversity may present specific challenges to HEIs due to the potential for different learning needs within these groups [9], there remains limited literature and a lack of clarity as to the 2 specific challenges this may present within physiotherapy. Examples of previous research includes the suggestion that mature students in general are effective learners, more motivated and achieve more academically than younger students [3]. Conversely, there is also limited data within physiotherapy suggesting achievement of a better final degree classification by standard entry students [10].Research considering the performance of physiotherapy students based on gender, presents a decline in performance of mature male physiotherapy students when measured for aspiration, satisfaction and identity as a learner as part of a series of questionnaire studies across all three years of physiotherapy training [11]. A later study by Hammond [6] focussed on clinical placement performance alongside related academic requirements (such as reflection portfolio's) both indicated better attainment by female students (female grades 3% higher, p=0.001). There was also a significant increase in the number of male students failing clinical placements in comparison to their female counterparts (13% male vs. 2% female).At present, there is no literature considering physiotherapy students in the UK and the potential relationship between ethnicity and performance. American literature suggests the potential of covert bias in the evaluation of physical therapy student's clinical performance based on ethnicity; with those from minority ethnic groups marked lower [12]. Although there are some significant limitations with this study, corroboration for these findings is in part provided in a later study by Clouten et al [13], who report that a small but significant number of physical therapy clinical instructors...

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Section: Discussionmentioning

confidence: 99%

Does ethnicity, gender or age of physiotherapy students affect performance in the final clinical placements? An exploratory study

2014

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“…Questions about the ethnic background of the students pertaining to the country of birth of the student and parents and the language spoken with parents were included in the survey (Stegers-Jager et al 2012b). Ethnic minority was defined according to the Statistics Bureau of the Netherlands (CBS, www.cbs.nl) as “a person with at least one parent born outside the Netherlands.” The classification of ethnic minorities in five groups was also in alignment with CBS: “Turkish/Moroccan/African, Surinamese/Antillean, Asian (including Chinese), Western (including European, North American and Oceanian, Indonesian, and Japanese), and Other” (Stegers-Jager et al 2012b).…”

Section: Methodsmentioning

confidence: 99%

The role of study strategy in motivation and academic performance of ethnic minority and majority students: a structural equation model

Isik

Wilschut

Croiset

et al. 2018

Adv in Health Sci Educ

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Underperformance among ethnic minority students has been reported in several studies. Autonomous motivation (acting out of true interest or personal endorsement) is associated with better learning and academic performance. This study examined whether study strategy (surface, achieving, and deep) was a mediator between the type of motivation (autonomous and controlled motivation) and academic performance (GPA and clerkship performance), and whether these relations are different for students from different ethnic groups to gain a better understanding about the needed intervention/support in the curriculum. Data was gathered from 947 students at VUmc School of Medical Sciences, Amsterdam. Structural Equation Modelling was performed to test the hypothesized model: a higher autonomous motivation has a positive association with academic performance through deep and achieving strategy, and has a negative association with performance through surface strategy. The model with the outcome variables GPA and clerkship performance had a good fit (n = 618; df = 1, RMSEA = 0.000, p = 0.43). The model for the ethnic majority and minority groups was significantly different (p < 0.025). In this study, autonomous motivation had a positive association with GPA through achieving strategy for the ethnic majority students only. It might be that the size of the minority groups was too small to detect differences or that other factors mediate these relations in ethnic minority students. Qualitative research is needed to identify other factors influencing the academic performance of ethnic minority students and what they experience during their education, in order to support their learning in the right manner.

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“…Studies from Australia and the Netherlands show that they underperform in the first year of medical school (Kay-Lambkin et al 2002; Stegers-Jager et al 2012) and also later in the course, in final year assessments in Australia, the UK and the USA (Liddell and Koritsas 2004; McManus et al 1996; Xu et al 1993). A systematic review and meta-analysis showed that ethnic minority students in the UK academically underperform compared with white students throughout medical school and across different types of examinations (Woolf et al 2011).…”

Section: Introductionmentioning

confidence: 99%

“…Others found that they received lower grades in their clerkships (Lee et al 2007; Stegers-Jager et al 2012). The underperformance in clinical assessments of ethnic minority students was also found among physiotherapy students (Naylor et al 2014).…”

Section: Introductionmentioning

confidence: 99%

“…Several authors have reported that ethnic disparities in the pre-clinical course were less profound than in the clinical course (Stegers-Jager et al 2012; Yates and James 2007). Woolf et al (2008) found ethnic differences on both written and OSCE assessments, but the difference on the written assessments disappeared when it was adjusted for OSCE performance, while it remained on the OSCE when adjusted for written performance.…”

Section: Introductionmentioning

confidence: 99%

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Ethnic and social disparities in different types of examinations in undergraduate pre-clinical training

Stegers‐Jager

Brommet

Themmen

2016

Adv in Health Sci Educ

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Medical schools are increasingly faced with a more diverse student population. Generally, ethnic minority students are reported to underperform compared with those from the ethnic majority. However, there are inconsistencies in findings in different types of examinations. Additionally, little is known about the performance of first-generation university students and about performance differences across ethnic minority groups. This study aimed to investigate underperformance across ethnic minority groups and by first-generation university students in different types of written tests and clinical skills examinations during pre-clinical training. A longitudinal prospective cohort study of progress on a 3-year Dutch Bachelor of Medicine course was conducted. Participants included 2432 students who entered the course over a consecutive 6-year period (2008–2013). Compared with Dutch students, the three non-Western ethnic minority groups (Turkish/Moroccan/African, Surinamese/Antillean and Asian) underperformed in the clinical problem solving tests, the language test and the OSCEs. Findings on the theoretical end-of-block tests and writing skills tests, and results for Western minority students were less consistent. Age, gender, pre-university grade point average and additional socio-demographic variables (including first-generation university student, first language, and medical doctor parent) could explain the ethnicity-related differences in theoretical examinations, but not in language, clinical and writing skills examinations. First-generation university students only underperformed in the language test. Apparently, underperformance differs both across ethnic subgroups and between different types of written and clinical examinations. Medical schools should ensure their assessment strategies create a level playing field for all students and explore reasons for underperformance in the clinical and writing skills examinations.

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Ethnic disparities in undergraduate pre‐clinical and clinical performance

Cited by 53 publications

References 33 publications

Does ethnicity, gender or age of physiotherapy students affect performance in the final clinical placements? An exploratory study

Does ethnicity, gender or age of physiotherapy students affect performance in the final clinical placements? An exploratory study

The role of study strategy in motivation and academic performance of ethnic minority and majority students: a structural equation model

Ethnic and social disparities in different types of examinations in undergraduate pre-clinical training

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