Investigating The Reasons For Under Performance In Ethnic Minority Medical Students


  1. Rumbidzai Chandauka
  2. Jean Marion Russell and Pirashanthie Vivekananda-Schmidt


Student wellbeing


University of Sheffield


It has been previously reported that ethnic minority students academically underperform compared to their white counterparts. This project aimed to identify whether amongst medical students1-5, there is a relationship between ethnicity and the following factors: satisfaction with academic performance, sense of belonging and cultural influence.

Summary of Work


An online questionnaire (quantitative and qualitative) was completed by 352 medical students from the University of Sheffield (70%; 246 students), Keele University (21%; 73 students) and London Universities (9%; 32 students). Ethnic distribution was 73.3% caucasian (258 students), 5.4% mixed race (19 students) and 21% ethnic minorities (EM)(74 students). The Statistical Package for the Social Sciences was used for statistical analysis. This included logistical regression, Pearson chi tests, Krsukall Wallis and Mann Whitney tests.


There are clear differences that exist between ethnicities in self-perceived satisfaction with academic performance, sense of belonging and insight into characteristics important for their student role. Further research should focus on better understanding of these differences, and their manifestations and developing appropriate interventions to optimise learning.

Take-home Messages
  1. Reasons for underperformance of EMs are multifactorial.
  2. Further investigation on the impact of stereotyping in the clinical learning/teaching contexts needs to be undertaken. This should lead to strategies that better support EM. 
  3. Better awareness of the differences reported here may help EM medical students in developing positive strategies to improve integration and belonging in the medical school community. 
  1. Dewhurst, N.G., McManus, C., Mollon, J., Dacre, J.E. and Vale, A.J. (2007) Performance in the MRCP (UK) Examination 2003 4: analysis of pass rates of UK graduates in relation to self-declared ethnicity and gender. BMC Medicine, 3(5), p.8.
  2. McManus, I.C., Richards, P., Winder, B.C. and Sproston, K.A. (1996) UK final examination performance of medical students from ethnic minorities. Medical Education, 30(3), p.195–200.
  3. Woolf, K., Cave, J., Greenhalgh, T., and Dacre, J. (2008) Ethnic stereotypes and the underachievement of UK medical students from ethnic minorities: qualitative study. British Medical Journal (Clinical research ed.), 337, p.611-614.
  4. Woolf, K., Haq, I., McManus, I., Higham, J. and Dacre, J. (2008) Exploring the underperformance of male and minority ethnic medical students in first year clinical examinations. Advances In Health Sciences Education, 13(5), p.607-616.
  5. Woolf, K., Potts, H.W.W. and McManus, I.C. (2011) Ethnicity and academic performance in UK trained doctors and medical students: systematic review and meta-analysis. British Medical Journal, 12(7797), p.342.
  6. Office for National Statistics, 2003 Ethnic group statistics: A guide for the collection and classification of ethnicity data London: HSMO. Available from: (accessed 2012/02/24)
Summary of Results


 EMs were more dissatisfied with their academic performance (p<0.001).


Quote 1 - EM student: "I sometimes feel I could perform better in certain areas."


EMs were less likely to feel they belonged to the medical community (p<0.05). Students measured sense of belonging using their relationships with other students and finding activities that met their interests within the medical school. 


Quote 2 - Caucasian student: "I'm a medical student, I have friends who are medics and I go to some of their socials"


Quote 3 - EM student: "MEDSOC socials = booze most of the time, with a select group/clique on the forefront... Much more involved with the Union, where there is less prejudice and more tolerance towards ethnic minorities and international students! Med School isn't very good at realising that not everyone is the same and that some people take more time to adapt to a new environment/ new culture."   (MEDSOC is the student unions medical society)






With regards to an ideal medical student’s behavioural trait, caucasians were more likely to choose confidence (p<0.05). Regarding what main behavioural traits are emphasised during their upbringing, caucasians chose extraversion (p<0.05), mixed race students openness to experience (p<0.05) and EMs chose respectfulness (p<0.001).This reinforced the stereotyping cited in Woolf et al's research which may result in a negative impact on clinical experience/teaching for EMs whilst caucasions are positively impacted.

Quote 4 - Caucasion Student: "I think that there is definitely a confidence difference between those who have lived in the UK before university and those who have moved here only for university. As this course definitely requires a high confidence level, not only to be confident of your own academic performance amongst your peers but also from a social point of view, this may impact on academic performance. This lack of confidence can only be confounded by a reduced capacity for the English language - a real problem for the international students that should be a priority to be tackled by the university."




Participants believed the causes for variations in performance were an interplay between cultural influences, ethnic stereotyping, and communication skills. 


Quote 5 - EM Student: "Stereotypes and discrimination by staff and patients affects clinical learning: 1. Quality of delivery and knowledge passed on. If you are a foreigner people suspect possible incompetence. So it feels you have to work twice as hard to achieve that same acknowledgement. 2. Family commitments especially extended family that others students do not seem to have.3. Learning slang and culture of the work place so you can fit in as much as possible."


Qoute 6 - EM Student: "As I wear a headscarf, I feel I have to make my dress more westernised in order to feel accepted and treated more fairly by patients and staff."


Quote 7 - EM Student: "Different opportunities may be given according to different ethnic background (it is not as serious as racism)."




Culture influenced behavioural traits and communication skills including the proficiency and accent of the spoken communication (English). 


Quote 8 - EM Student: "The main barrier I feel is the language one which can impede understanding, shy to ask for help and put themselves forward, which may be a cultural thing or fear of embarassment."


Quote 9 - Caucasion Student: "I have a broad north eastern accent which has in the past been commented on by my peers and tutors, I therefore try and modify this in the medical environment.  As people treat me as being unintelligent when I speak with my regional accent."


We would like thank all the participants for their valued contribution.  We would like to thank Dr Lauren Brooks and Judith Rock (Keele University), Royal Society of Medicine, and the MDU Student section for disseminating our recruiting email. 



























Summary of Work

Ethnic groupings used in the questionnaire mirrored the Office for National Statistics6 classifications. However, as low numbers across various EM classifications impeded meaningful statistical analysis, ethnic groupings were reclassified to white, mixed race and all other races (non-whites). The mixed race classification (white and other) was kept separate during data analysis in case their exposure to two different ethnic cultures made them different.

Take-home Messages
Summary of Results

Examples of observations made by participants regarding sense of belonging.

Quote 1a - Caucasian student: "In medicine there is a feeling of being part of a large community with many diverse backgrounds but a common purpose. Although there are few events that bring everyone together, organisations like MedSoc provide an invaluable service in looking after the welfare of all students."

Quote 1b - EM student: "... Socials do not cater the needs of different type of students taking into consideration of religious background and age. facilities to encourage integration like a common room for medical students do not exist." 

Qoute 1c - EM student: " I have a different lifestyle and as a foreigner a different set of problems and therefore people around me do not really understand."


Examples of observations made by participants regarding stereotyping:.

Qoute 7a - Caucasian student: "I think that the way colleagues and patients interact with people from different cultures will have a huge impact on performance. I have seen on a number of occasions how patients interact differently with people from different ethnic backgrounds. Cultural ideas will also impact performance and affect practice. Personal opinions and religious beliefs will always play some role in how patients are treated."

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