Diversity Audit of Medical School Examination Questions

Area of Science:

• Medical Education Research
• Health Equity Studies
• Sociology of Health

Background:

• Medical school examinations are key assessment tools.
• Patient diversity in these assessments is under-researched.
• Current curricula increasingly emphasize cultural competence and social determinants of health.

Purpose of the Study:

• To audit the portrayal of demographic, social, and economic diversity in medical school examination questions.
• To assess the representation of various patient characteristics beyond age and gender.
• To inform improvements in medical education assessment to reflect patient diversity.

Main Methods:

• A systematic audit of 3,566 pre-clinical and clinical multiple-choice and short-answer questions from three medical schools across two continents in 2018.
• Analysis extended Critical Race Theory principles to include social determinants of health.
• Categorization of patient characteristics presented in examination questions.

Main Results:

• Patients were described in 43.1% of questions.
• Age (89.4%) and binary gender (93.9%) were commonly depicted.
• Other diversity aspects like ethnicity (7.2%), socioeconomic status (0.5%), sexual identity (1.1%), and disability (0.1%) were rarely included, with non-binary genders, residency status, and religion/spirituality absent.

Conclusions:

• The limited portrayal of patient diversity in medical exams may hinder authenticity and the teaching of diversity in medicine.
• Medical schools should regularly audit and enhance patient diversity in examination questions.
• Improved representation supports effective teaching and learning about diverse patient populations.