Considering evidence for ethnicity bias using assessment case scenarios and medical student correctness and certainty.

AIMS: There is inequitable distribution of health risks, exposures, resources and outcomes by ethnicity. This may be contributed to by health professional bias. The aim of this study was to investigate the relationship between ethnicity of patients, within written assessment case scenarios, and medical students' response correctness and certainty.

METHODS: Otago Medical School students sit a 150 MCQ progress test with item level response certainty. Patient ethnicity for 60 MCQ case scenarios was varied between two ethnic groups (New Zealand European, Māori) and none specified. Analysis of responses by patient ethnicity was undertaken to compare: odds of correctness; level of certainty; correctness for level of certainty and also by year groups and ability.

RESULTS: One thousand one hundred and three students sat the test. There was no significant difference in odds of correctness or level of certainty by the ethnicity of the patient case scenario. These did not differ significantly by year groups or ability groups, or for correctness by level of certainty.

CONCLUSIONS: No systematic differences in correctness or certainty of student responses to case scenarios by patient ethnicity were detected. Further exploration is warranted, including incorporating more ethnicity descriptors, analysis of incorrect answers, analyses for patterns responses over time by individual students, and selecting questions where varying patient ethnicity is expected to alter the correct response or difficulty.