The influence of candidates’ race on examiners’ ratings in standardised assessments of clinical practice

Abstract

Purpose

Delivering fair and reliable summative assessments in medical education assumes examiner decision making is devoid of bias. We investigated whether candidate racial appearances influenced examiner ratings in undergraduate clinical exams.

Methods

We used an internet-based design. Examiners watched a randomised set of six videos of three different white candidates and three different non-white (Asian, black and Chinese) candidates taking a clinical history at either fail, borderline or pass grades. We compared the median and interquartile range (IQR) of the paired difference between scores for the white and non-white candidates at each performance grade and tested for statistical significance.

Results

160 Examiners participated. At the fail grade, the black and Chinese candidates scored lower than the white candidate, with median paired differences of −2.5 and −1 respectively (both p < 0.001). At the borderline grade, the black and Chinese candidates scored higher than the white candidate, with median paired differences of +2 and +3, respectively (both p < 0.001). At the passing grade, the Asian candidate scored lower than the white candidate (median paired difference −1, p < 0.001).

Conclusion

The racial appearance of candidates appeared to influence the scores awarded by examiners, but not in a uniform manner.

Keywords:

• Awarding gap
• assessment
• differential attainment
• medical education
• race

Acknowledgments

The authors are grateful to the UK Medical Schools Council (MSC) for their support with this project.

Disclosure statement

No potential conflict of interest was reported by the author(s).

Additional information

Funding

The MSC funded the recruitment of the simulated candidates, simulated patients and recording equipment. Professor C. Brown is supported by the NIHR Applied Research Collaboration (ARC) West Midlands. Professor M. Gurnell is supported by the National Institute for Health Research (NIHR) Cambridge Biomedical Research Centre [BRC-1215-20014]. The views expressed are those of the authors and not necessarily those of any association or society.

Notes on contributors

Celia Brown

Celia Brown, PhD, SFHEA, Division of Health Sciences, Warwick Medical School, Coventry, UK.

Sarah Khavandi

Sarah Khavandi, BSc, MBBS, Imperial College School of Medicine, Imperial College London, UK.

Ann Sebastian

Ann Sebastian, BSc, MBBS, Imperial College School of Medicine, Imperial College London, UK.

Kerry Badger

Kerry Badger, BMedSci, BMBS, MPH, MEd, Imperial College School of Medicine, Imperial College London, UK.

Rachel Westacott

Rachel Westacott, MB, ChB, FRCP, Birmingham Medical School, University of Birmingham, Birmingham, UK.

Malcolm W. R. Reed

Malcolm W. R. Reed, MD, BMedSci, MBCHB, FRCS, Brighton and Sussex Medical School, University of Sussex, Brighton, UK.

Mark Gurnell

Mark Gurnell, PhD, MA(MEd), FHEA, FAcadMEd, FRCP, Wellcome–MRC Institute of Metabolic Science, University of Cambridge and NIHR Cambridge Biomedical Research Centre, Cambridge University Hospitals, Cambridge, UK

Amir H. Sam

Amir H. Sam, PhD, FRCP, SFHEA, Imperial College School of Medicine, Imperial College London, UK.