Study: Lower Grades For APA Medical Students
December 12, 2007
Cultural differences in communication may affect grades
ST. LOUIS — Asian American students are underperforming compared to their white counterparts in medical school for reasons that seem to suggest a lack of cultural understanding in one of the highest echelons of academia, according to a study published in the October issue of the Journal of the National Medical Association.
The study, conducted by researchers from Washington University in St. Louis and the University of California in San Diego, focused on the critical two-year period that comprises the final half of a medical school program. Medical school begins with two years of classroom learning where achievement is measured by written exams, after which students enter two years of hands-on hospital training, known as clinical clerkships.
This study examined how interpersonal communication skills and factors such as race and gender might codetermine performance during clerkships.
“A report that came out 10 years ago showed that Asian medical students received lower grades [at one particular] medical school, even though they had higher MCAT scores and incoming grades,” said report co-author Katherine B. Lee, national president of the Asian Pacific American Medical Student Association. “We went to a national study just to figure out some of the reasons, and if it is still true that minorities are receiving lower grades.”
Via an anonymous online survey, participants indicated the extent of their agreement to statements such as “I have made sure that important people know who I am” and “I do not always ask questions because I’m afraid people will think my questions are foolish.” The survey also tracked age, gender, ethnicity, country of birth and grades earned in clinical clerkships. Data was collected from more than 2,300 medical students from 105 medical schools nationwide.
The results indicate that Asian Americans, among other minorities, reported lower overall grades than whites, and white medical students may receive higher grades from observing physicians because they are more assertive than their minority classmates; Asian American students scored lower on the assertiveness characteristic than their white counterparts.
“We looked at variables that predicted lower grades,” Lee said. “The most consistent variable was that of race, even controlling for other variables such as gender, country of birth and language.”
The finding is surprising because it contradicts the widespread “model minority” view of Asian American students, who are perceived to excel in academics. Lee theorized that Asian American medical students may receive lower grades not because of academic ability, but because their culturally motivated styles of communication come across negatively in a classroom or clerkship environment.
According to an educational module produced by APAMSA, Asian Americans who are taught to be quiet, studious and formal may instead be viewed as passive, unassertive and not inquisitive. APAMSA also cited an Ohio State University study showing that Asian American parents gave significantly less motivation to their children to participate in extracurricular activities or hold part-time jobs than white parents. The lack of these experiences may also contribute to a lack of the communication, teamwork and leadership skills that clinicians look for in their students.
“Many minority students reported being more shy than white students,” Lee said. “But their cultural values may differ from those of the [physicians] that are evaluating them. For example, an Asian American trying to show respect may be seen as being too quiet.”
Up to 70 percent of a grade earned during clerkship is determined by comments and ratings from observing physicians. Clerkship grades are the leading predictor of a medical student’s ability to achieve residency in a hospital, a crucial step in the path to becoming a practicing physician.
These findings are important because a lack of diversity in the physician workforce has consistently been cited as an obstacle to eliminating health care disparities.
“Particularly alarming is the possibility that institutionalized biases exist, which affect the grades of minority medical students and the career advancement of minority physicians,” Lee said. “This study highlights the lack of cultural awareness of the medical community, which ultimately may be detrimental to patient care.”
Lee emphasized that improvement will arise not only from the cultural education of observing physicians, but also from Asian American students’ awareness of the issues.
“Asian Americans, we tend to blame ourselves,” Lee said. “Maybe we didn’t work hard enough or didn’t speak English well enough. But for a lot of these Asian Americans, there is no language barrier. It’s almost like there is a glass ceiling.”
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5 Responses to “Study: Lower Grades For APA Medical Students”
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While I commend Ms. Lee for completing such a large and unique survey towards the medical education system, there are some typical conclusions that this paper implies that are really getting exhausting to listen to. Maybe minority students can learn something from the white students who are scoring better, this country likes doctors who speak up and who we can understand! So, instead of blaming the “white man”, learn from him, and better your language and speaking skills, then let’s see if your grades improve, as well as your physician abilities…
The obvious rebuttal to these assertions are that these totally subjective results may be the results of racism. It is well known that racism is alive and well in this country. I would be very interested to find how patient outcomes differed and how shelf scores differed.
I am an APA medical student and I would characterize myself as assertive and sociable. I do believe that these traits are important during the clinical years because you are graded on a subjective basis. The attendings are evaluating students based on medical knowledge as well as the communication of that knowledge and the ability to work as a team (both important skills in medicine). Passivity and reticence severely reduce many asian students’ ability to convey their knowledge and work in a team setting. I have witnessed this first hand and really feel sorry for asian students who are struggling to speak up or assert themselves.
lj,
why we gotta be like the white man? stop being oppressed and stand up! just because things are done a certain way doesn’t mean they have to be superimposed on the minority that doesn’t do it that way.
Even if an Asian student does work similar in quality to that of a white student, the results can be perceived quite differently by attendings and residents because of preconceived ideas. For example, an attending might expect more of an Asian student such that the Asian student has to be exceptional to be seen as just slightly above average. A black colleague of mine told me he faces the opposite stereotype every day: his attendings and residents are amazed when he knows what’s going on.