title: Ethnic disparities in undergraduate pre-clinical and clinical performance.
abstract: BACKGROUND
  Research from numerous medical schools has shown that students from ethnic minorities underperform compared with those from the ethnic majority. However, little is known about why this underperformance occurs and whether there are performance differences among ethnic minority groups.
  
  
  OBJECTIVE
  This study aimed to investigate underperformance across ethnic minority groups in undergraduate pre-clinical and clinical training.
  
  
  METHODS
  A longitudinal prospective cohort study of progress on a 6-year undergraduate medical course was conducted in a Dutch medical school. Participants included 1661 Dutch and 696 non-Dutch students who entered the course over a consecutive 6-year period (2002-2007). Main outcome measures were performance in Year 1 and in the pre-clinical and clinical courses. Odds ratios (ORs) with 95% confidence intervals (CIs) 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) and previous performance at medical school.
  
  
  RESULTS
  Compared with Dutch students, Surinamese and Antillean students specifically underperformed in the Year 1 course (pass rate: 37% versus 64%; adjusted OR 0.40, 95% CI 0.27-0.60) and the pre-clinical course (pass rate: 19% versus 41%; adjusted OR 0.57, 95% CI 0.35-0.93). On the clinical course all non-Dutch subgroups were less likely than Dutch students to receive a grade of ≥ 8.0 (at least three of five grades: 54-77% versus 88%; adjusted ORs: 0.17-0.45).
  
  
  CONCLUSIONS
  Strong ethnic disparities exist in medical school performance even after adjusting for age, gender, pu-GPA and socio-demographic variables. More subjective grading cannot be ruled out as a cause of lower grades in clinical training, but other possible explanations should be studied further to mitigate the disparities.
authors.affiliation: Erasmus MC Desiderius School, Erasmus University Medical Centre, Rotterdam, the Netherlands. k.stegers-jager@erasmusmc.nl
authors.forename: Karen M
authors.initials: KM
authors.lastname: Stegers-Jager
authors.forename: Ewout W
authors.initials: EW
authors.lastname: Steyerberg
authors.forename: Janke
authors.initials: J
authors.lastname: Cohen-Schotanus
authors.forename: Axel P N
authors.initials: AP
authors.lastname: Themmen
mesh_terms: D002983:Clinical Competence / Q000592:standards*; D015331:Cohort Studies; D003479:Curriculum / Q000592:standards; D004504:Education, Medical, Undergraduate / Q000592:standards*; D004521:Educational Measurement / Q000379:methods* / Q000592:standards; D005006:Ethnicity / Q000193:education* / Q000523:psychology; D005260:Female; D006801:Humans; D016015:Logistic Models; D008137:Longitudinal Studies; D008297:Male; D008913:Minority Groups / Q000193:education* / Q000523:psychology; D009426:Netherlands; D011446:Prospective Studies; D044469:Racial Groups / Q000193:education / Q000523:psychology; D012959:Socioeconomic Factors; D013337:Students, Medical / Q000523:psychology*; D014477:Underachievement