Today’s Weekend Australian
28/1/17 – News Article Commentary
The Australian College of Emergency Medicine (ACEM) has been accused of systemic racism by more than 30 non-white students, who have revealed their white colleagues are 13 times more likely to be admitted as specialist emergency doctors.
The students have lodged a highly detailed 34-page complaint with the college showing that, of 204 candidates participating in the program for the second half of last year, non-white candidates — who make up more than a quarter of all enrolments — had a clinical exam pass rate of just 6.8 per cent.
That compared with a pass rate of 88 per cent for their white classmates. The clinical exam is the last hurdle for doctors attempting to become emergency specialists and exams are taken twice a year.
The group of 33 non-white students who have filed the complaint say the vast disparity in results cannot be explained by poorer skills or language issues, given they have worked alongside their white counterparts for years in hospitals and shared the same training. The students were all fluent in English, and many spoke English as their first language.
“That the college would pass less than 10 per cent of the non-caucasian cohort, deeming the rest unfit to be emergency medicine specialists, while passing the vast majority of caucasian candidates is embarrassing to the college,” write the students. “It is far out of step with community standards as well as being clearly … discriminatory.”
College spokesman Fin Bird said: “We can’t comment on the specifics of any case … to respect the integrity of the process and confidentiality of the applicants.’’
The group of students — who have requested confidentiality for fear of career repercussions — want the college to “statistically modify” last year’s clinical exam results to “remove the clear element of racial bias from them”.
The students have also filed the complains to the Australian Medical Council, which oversees grants and accreditation of the ACEM and all other specialist medical training colleges. Council chief executive Ian Frank told The Weekend Australian his organisation was aware of the complaint but was seeking more details before it could comment further.
In 2015, the Australian Medical Council introduced new policy regarding assessment and accreditation standards and this year, for the first time, the college will have its accreditation practices reviewed under the new standards.
The students said while the college did not publish student results, they had been in contact with 59 non-white students from last year and found just four had passed the clinical exam. One of those students who spoke with The Weekend Australian said he had repeatedly failed the exam and the “racial discrimination” had a demoralising effect on him and many non-white students.
“We are looked down on by our fellow colleagues and consultants after repeated failures as if we are not trustworthy,” he said. “This exam had made me lose the happiness I had working in emergency medicine.”
The students listed pass rates for all hospitals where ACEM students worked. At Newcastle’s John Hunter Hospital all four white candidates passed, but all five non-white candidates failed. At Canberra Hospital, one of the two white candidates passed while all three non-white candidates failed; and at Brisbane’s Prince Charles Hospital all four white candidates passed while the only two non-white candidates failed.
This report was first published on 28/1/17
Comments and Ideas on this Pressing Issue
Feedback on this article is very divisive on twitter already:
This is a really sad situation (as reflected by the on-going list of comments below).
The notion of issues with ethnic imbalance in exam success was reported 10 years ago in the UK MRCP exam system (and 20 years ago in the UK undergraduate medical exam system). The data on pass rates is publicly available and it has been documented that overseas doctor suffer prejudice when integrating in Western medical systems.
This ‘LINK‘ takes us the the MRCP gender and ethnicity equality report from 2015, a relatively similar high stakes post graduate medical exam in the UK.
The following graph from this report shows the pass marks for the UK MRCP clinical examination:
This graph appears to show that your chance of passing is 989/2291 (43%) if you are a non-white overseas doctor compared to 789/920 (85%) for white locally trained doctors. Therefore, a gap in performance based on ethnicity appears to be widespread – not unique Australasian Emergency Medicine. In summary, it appears pass rates are significantly lower for international medical graduates (IMG) in many medical exams.
Furthermore, our FOAMed friend Dr Simon Carley (@EMManchester) raised this issue at the St Emlyn’s blog at the end of last year. He quoted General Medical Council (GMC) data suggesting that not only to overseas trained doctors have lower pass rates, but so do locally trained candidates from an ethnic minority background.
From these international trends (which are clearly not unique to the challenging ACEM exam) – I think we can conclude at least a few things about the situation in 2017:
- The issue of why the international medical graduate’s pass rate is so low is likely much more complicated than ‘inherent racism’
- Most local Directors of Emergency Medicine Training (DEMTs) can accurately predict based on rehearsal performance who is going to pass and fail the ACEM exam
- This could suggest a inherent cognitive bias by FACEMs towards what is deemed a ‘correct exam performance’. Alternatively, this could suggest there is no ‘systemic’ deliberate attempt to fail any one group of candidates.
- Other contentious factors may be at play to drop the pass rates – this may include IMG assessments in their baseline medical education (exposure to OSCEs at under graduate level), approach to study (rote learning)… There may be a number of other factors which are as yet not recognised which lead to certain candidates not translating their knowledge into an exam success.
- The comments section (below) reflects a range of views on how much racial discrimination is a factor in college examination
- ACEM like the the UK RCP need to be transparent in its reporting and be proactive in attempts to improve all candidates performance in examinations
Dr Katherine Woolf completed her PhD on this issue.
We believe, her work is worth a look as she is one of the top reporters on the subject of why ethnic minorities under-perform in both undergraduate and postgraduate exams:
Woolf et al (BMJ META-ANALYSIS (2011)) – ‘Ethnic differences in attainment seem to be a consistent feature of medical education in the UK, being present across medical schools, exam types, and undergraduate and postgraduate assessments, and have persisted for at least the past three decades. They cannot be dismissed as atypical or local problems. This is an uncomfortable finding, with good reason. While exam performance is by no means the only marker of good performance as a doctor or medical student, the fact remains that without passing finals, medical students cannot become doctors, and without passing postgraduate exams, it is much harder for doctors to progress in a medical career. That exam results vary by ethnicity is therefore extremely important and requires attention. Although ethnicity is clearly related to exam performance, what is not clear is why that might be‘……….. ‘Ethnic differences in academic performance are widespread across different medical schools, different types of exam, and in undergraduates and postgraduates. They have persisted for many years and cannot be dismissed as atypical or local problems. We need to recognise this as an issue that probably affects all of UK medical and higher education. More detailed information to track the problem as well as further research into its causes is required. Such actions are necessary to ensure a fair and just method of training and of assessing current and future doctors.’