Women from all ethnic backgrounds are more successful at passing UK medical exams than their male counterparts, according to research published today in the open access journal BMC Medicine. The research, which looked at gender and racial factors in medical exam success, also found that non-white males do least well in medical examinations.
The research, undertaken by Dr Neil Dewhurst, Jennifer Mollon and Dr Allister Vale of MRCP(UK) in collaboration with Professor Chris McManus and Professor Jane Dacre, senior researchers at University College London, assessed candidates taking the MRCP(UK) examination during 2003-4. They investigated 5711 examination attempts by 3650 candidates almost 90% of whom declared their ethnicity.
The MRCP(UK) exam consists of two written exams that are machine marked. In an additional clinical test, a consultant physician examiner assesses candidates' skills in clinical judgement, communications and ethics. The MRCP(UK) exam is taken by trainee physicians and all parts must be passed before going onto higher medical training in their chosen specialty.
The researchers found that gender did not make a significant difference in the two written exams. However, the study shows that white candidates were more likely to pass than non-white candidates in all parts of the exam. As the written exams are machine marked, the poor performance of non-white candidates cannot be attributed to examiner bias.
The differences were most pronounced in the clinical examination. In general, women performed better than men across all parts of the clinical tests, both in communication skills and in their skills in examining patients. As a result they were over one-and-a-half times (1.69) more likely to pass than males. White candidates were significantly more likely to succeed (pass rate 75.5%) than non-white candidates (pass rate 60.3%). This is consistent with other international research findings. Non-white males were the least successful, performing less well than white males and non-white females. Non-white males' performance was less strong in all aspects of the clinical examination, but the poor performance was most marked in the communications and ethics assessments.
The researchers also investigated whether there was any indication of examiner bias in the clinical examination. Analysis of the gender and ethnicity of examiners showed no evidence of the gender of the examiner making a significant difference. The only significant effect was shown in just one assessment area (communications and ethics), where there was an improved performance of non-white candidates examined by two non-white examiners.
The study concludes that there are significant variations in the pass rates for UK graduates but that this was not primarily a result of examiner bias.
"At a time when more non-white ethnic groups are entering medical schools, this research raises important questions." says Dr Dewhurst, Medical Director of the MRCP(UK). "Are there language and cultural issues? Are there issues to do with medical school candidate selection? Is it more difficult for the non-white candidates to pass if they only come to the UK for their medical undergraduate training or part of it? Or perhaps the best non-white medical trainees are selecting other career options such as surgery, or general practice, rather than becoming physicians".
Article: Performance in the MRCP(UK) Examination 2003-4: Analysis of pass rates of UK graduates in relation to self-declared ethnicity and gender Neil G Dewhurst, Chris I McManus, Jennifer Mollon, Jane E Dacre and Allister J Vale BMC Medicine (in press)
Editors notes provided by authors
- The results are broadly in line with other research into the success rate of candidates in other medical exams. Nonetheless research into "high stakes" postgraduate medical exams is more limited than similar research into exams at undergraduate level.
- The MRCP(UK) Examination assesses the knowledge and clinical skills of trainee physicians before they undertake higher training in their chosen specialty. It consists of Part 1 and Part 2, both written examinations, both machine marked. There is also a Clinical Examination. In this part of the examination candidates are tested over 5 stations, where there are 14 separate assessments, by 10 examiners. The exam assesses competence in all aspects of the clinical consultation including communications and ethics and tests skills in examining patients.
- The MRCP(UK) exam is set by the Federation of Royal Colleges of Physicians. This comprises the Royal College of Physicians of Edinburgh and the Royal College of Physicians of London and the Royal College of Physicians and Surgeons of Glasgow. The Federation is responsible for the development and delivery of the MRCP(UK).
- The research was conducted as part of the ongoing programme of research into the performance and reliability of the exam that is part of the MRCP(UK) quality assurance programme.