Student perspectives on barriers to performance for black and minority ethnic graduate-entry medical students: a qualitative study in a West Midlands medical school

Abstract

ObjectiveTo explore graduate-entry medical students experiences of undergraduate training in the context of academic underperformance of medical students from ethnic minority backgrounds.DesignQualitative study using semi-structured focus groups.SettingA West Midlands medical school.Participants24 graduate-entry MBChB students were recruited using volunteer and snowball sampling; all students self-identified as being from Black and Minority Ethnic (BME) backgrounds.ResultsBME students reported facing a range of difficulties, throughout their undergraduate medical training, that they felt impeded their learning and performance. Their relationships with staff and clinicians, though also identified as facilitators to learning, were also perceived to have hindered progress, as many students felt that a lack of BME representation and lack of understanding of cultural differences among staff impacted their experience. Students also reported a lack of trust in the institution’s ability to support BME students, with many not seeking support. Students’ narratives indicated that they had to mask their identity to fit in among their peers and to avoid negative stereotyping. Although rare, students faced overt racism from their peers and from patients. Many students reported feelings of isolation, reduced self-confidence and low self-esteem.ConclusionsBME students in this study reported experiencing relationship issues with other students, academic and clinical staff, lack of trust in the institution and some racist events. Although it is not clear from this small study of one institution whether these findings would be replicated in other institutions, they nevertheless highlight important issues to be considered by the institution concerned and other institutions. These findings suggest that all stakeholders of graduate-entry undergraduate medical education should reflect on the current institutional practices intended to improve student–peer and student–staff relationships. Reviewing current proposals intended to diversify student and staff populations as well as evaluating guidance on tackling racism is likely to be beneficial.

Role of sociodemographic factors and self-efficacy in the perception of social support of nursing students

“…Despite some authors pointing out that the interpersonal relationships that make up a social network tend to be homogeneous in several aspects such as sex, age, education, religion, and ethnicity (17)(18) , in the group studied, only the participants' ethnicity showed to be relevant in relation to the perception of social support.…”

“…Considering that the number of black/brown students in public universities is still small, this result may reflect the finding of a previous study developed with medical students, in which the authors identified a tendency to "homophily" in the constitution of the participants' support network, that is, they often named people of their own ethnicity as part of their support network (17) . The black students' interpersonal relationships were also indicated, in a previous study, as source of stress, as they felt underrepresented in relation to their specificities, an also because of the low sensitivity on the part of employees and teachers regarding sociocultural differences related to the question of race/color (18) .…”

Drivers and barriers to engaging with academia: a minority-ethnic medical student perspective

“…12 For minorityethnic students in particular, making, building and sustaining relationships are a challenge in a medical education context. 13 Relationships in an academic context are complex for various reasons; however, for minority-ethnic students, cross-cultural differences influence the way relationships are experienced. In particular, these differences appear to lead to feelings of isolation, 13 which can be particularly damaging in academia when collaborating with others is critical for success.…”

Racism in Medicine: Education and Employment

“…Beyond bias and discrimination in exams, performance is heavily influenced by: the relationships between students and their peers and staff; the relationship between students and their institution; and psychological, societal and cultural factors and experiences 30 . What the Atlantic has dubbed as "the stress of racism" erodes BAME students' sense of belonging and constrains their potential and progress 31,32 .…”