The influence of candidates' race on examiners' ratings in standardised assessments of clinical practice.

Purpose: Delivering fair and reliable summative assessments in medical education assumes examiner decision making is devoid of bias. We investigated whether candidate racial appearances influenced examiner ratings in undergraduate clinical exams.

Methods: We used an internet-based design. Examiners watched a randomised set of six videos of three different white candidates and three different non-white (Asian, black and Chinese) candidates taking a clinical history at either fail, borderline or pass grades. We compared the median and interquartile range (IQR) of the paired difference between scores for the white and non-white candidates at each performance grade and tested for statistical significance.

Results: 160 Examiners participated. At the fail grade, the black and Chinese candidates scored lower than the white candidate, with median paired differences of -2.5 and -1 respectively (both  < 0.001). At the borderline grade, the black and Chinese candidates scored higher than the white candidate, with median paired differences of +2 and +3, respectively (both  < 0.001). At the passing grade, the Asian candidate scored lower than the white candidate (median paired difference -1,  < 0.001).

Conclusion: The racial appearance of candidates appeared to influence the scores awarded by examiners, but not in a uniform manner.