[Impact of ethnicity and social background on examination results of medical students].

Objective: To investigate underperformance across ethnic minority groups and by first-generation university students in different types of examinations during pre-clinical training.
Design: Prospective cohort study
Methods: Participants included Erasmus MC students from the 2008-2013 cohorts (n=2432). Outcome measures were pass/fail on three types of written examinations: 1) theoretical knowledge: clinical problem solving tests (CPSTs) (Year 1-3) and end-of-block tests (Year 1c2-c3), 2) language skills test (Year 1) and 3) writing skills tests (Year 1-3), and OSCEs (Year 2-3). Odds ratios with 95% confidence intervals were estimated by logistic regression analysis for ethnic subgroups (Surinamese/Antillean, Turkish/Moroccan/African, Asian, Western) compared with Dutch students, adjusted for age, gender, pre-university Grade Point Average (pu-GPA), additional socio-demographic variables (first-generation immigrant, urban background, first-generation university student, first language, medical doctor as parent). Similar analyses were conducted for first-generation university students.
Results: Compared with Dutch students, the three non-Western ethnic minority groups underperformed in the CPSTs, the language test and the OSCEs. Findings on the end-of-block and writing skills tests, and results for Western minority students were less consistent. Age, gender, pu-GPA and additional socio-demographic variables could explain the ethnicity-related differences in theoretical examinations, but not in language, clinical and writing skills examinations. First-generation university students only underperformed in the language test.
Conclusion: Ethnic minority students underperform in pre-clinical training, but there are differences both across ethnic subgroups and between different types of examinations. In designing assessment programs care should be taken to avoid unintended effects of certain types of examinations for certain groups of students.