Yeates Peter, Woolf Katherine, Benbow Emyr, Davies Ben, Boohan Mairhead, Eva Kevin
Medical Education Research, School of Medicine, David Weatherall Building, Keele University, Newcastle under Lyme, ST5 5BG, UK.
Acute and Respiratory Medicine at Pennine Acute Hospitals NHS Trust, Bury, UK.
BMC Med. 2017 Oct 25;15(1):179. doi: 10.1186/s12916-017-0943-0.
Asian medical students and doctors receive lower scores on average than their white counterparts in examinations in the UK and internationally (a phenomenon known as "differential attainment"). This could be due to examiner bias or to social, psychological or cultural influences on learning or performance. We investigated whether students' scores or feedback show influence of ethnicity-related bias; whether examiners unconsciously bring to mind (activate) stereotypes when judging Asian students' performance; whether activation depends on the stereotypicality of students' performances; and whether stereotypes influence examiner memories of performances.
This is a randomised, double-blinded, controlled, Internet-based trial. We created near-identical videos of medical student performances on a simulated Objective Structured Clinical Exam using British Asian and white British actors. Examiners were randomly assigned to watch performances from white and Asian students that were either consistent or inconsistent with a previously described stereotype of Asian students' performance. We compared the two examiner groups in terms of the following: the scores and feedback they gave white and Asian students; how much the Asian stereotype was activated in their minds (response times to Asian-stereotypical vs neutral words in a lexical decision task); and whether the stereotype influenced memories of student performances (recognition rates for real vs invented stereotype-consistent vs stereotype-inconsistent phrases from one of the videos).
Examiners responded to Asian-stereotypical words (716 ms, 95% confidence interval (CI) 702-731 ms) faster than neutral words (769 ms, 95% CI 753-786 ms, p < 0.001), suggesting Asian stereotypes were activated (or at least active) in examiners' minds. This occurred regardless of whether examiners observed stereotype-consistent or stereotype-inconsistent performances. Despite this stereotype activation, student ethnicity had no influence on examiners' scores; on the feedback examiners gave; or on examiners' memories for one performance.
Examiner bias does not appear to explain the differential attainment of Asian students in UK medical schools. Efforts to ensure equality should focus on social, psychological and cultural factors that may disadvantage learning or performance in Asian and other minority ethnic students.
在英国及国际范围内的考试中，亚洲医学生和医生的平均成绩低于白人同行（这一现象被称为“成绩差异”）。这可能是由于考官偏见，或者是社会、心理或文化对学习或表现的影响。我们调查了学生的成绩或反馈是否显示出与种族相关的偏见影响；考官在评判亚洲学生表现时是否会不自觉地想起（激活）刻板印象；激活是否取决于学生表现的刻板印象程度；以及刻板印象是否会影响考官对表现的记忆。
这是一项基于互联网的随机、双盲、对照试验。我们使用英裔亚裔和英裔白人演员，制作了在模拟客观结构化临床考试中医学生表现的近乎相同的视频。考官被随机分配观看白人学生和亚洲学生的表现，这些表现与先前描述的亚洲学生表现刻板印象一致或不一致。我们在以下方面比较了两组考官：他们给白人和亚洲学生的分数和反馈；亚洲刻板印象在他们脑海中的激活程度（在词汇判断任务中对亚洲刻板印象词与中性词的反应时间）；以及刻板印象是否影响对学生表现的记忆（对其中一个视频中真实与虚构的刻板印象一致与刻板印象不一致短语的识别率）。
考官对亚洲刻板印象词的反应时间（716毫秒，95%置信区间（CI）702 - 731毫秒）比对中性词的反应时间（769毫秒，95% CI 753 - 786毫秒，p < 0.001）更快，这表明亚洲刻板印象在考官脑海中被激活（或至少是活跃的）。无论考官观察到的表现是与刻板印象一致还是不一致，这种情况都会发生。尽管有这种刻板印象激活，但学生的种族对考官的分数、考官给出的反馈或考官对一次表现的记忆没有影响。
考官偏见似乎并不能解释英国医学院校中亚洲学生的成绩差异。确保平等的努力应集中在可能使亚洲及其他少数族裔学生在学习或表现上处于不利地位的社会、心理和文化因素上。
