Time to normalise protected characteristics in written assessments: A mixed methods study

Abstract

Background Despite increasing endeavours to incorporate teaching material on healthcare for minority groups into medical school curricula, including cultural competency, there is a lack of research exploring medical students' comprehension of this. With age and gender as the only demographic information routinely provided in undergraduate single best answer (SBA) questions, the diversity of patients encountered by doctors in clinical practice is not fairly represented in assessments. This study examined the impact of not declaring gender or explicitly indicating LGBT+ identities and ethnicity, on how medical students evaluate clinical scenarios through SBA questions. Methods 200 medical students across clinical years completed 15 SBA questions in an online simulated exam. Participants were randomised to control and test groups testing different types of patient demographic information in question stems. Results Linear regression modelling demonstrated overall statistically nonsignificant differences between groups. The largest effect size was seen in the LGBT+ question intervention group, which had the fewest white and postgraduate participants. Older and more senior medical students performed better generally. White participants overall significantly outperformed non-white participants; this difference was eliminated when answering a mix of question styles. Using a mix of question styles produced statistically significant differences, with participants scoring worse on LGBT+ and ethnicity style questions. Conclusion Increased depth and breadth of clinical experience enables medical students to approach clinical scenarios with more flexibility. Unfamiliarity with minority patient groups may have impacted their performance in this study. For medical education to remain contemporary in preparing future clinicians to interact with diverse patient groups, assessments need to normalise the presence of these patients.