466 - The Impact of Faculty and Medical Student Racial and Ethnic Discordance on Pediatric Observed Structured Clinical Examination Scoring

Publication Number: 466.6551

Maria Demma Cabral, Cottage Children's Medical Center, Santa Barbara, CA, United States; Jocelyn Deleon, Western Michigan University Homer Stryker M.D. School of Medicine, Portage, MI, United States; Rebecca Carter, University of Maryland School of Medicine, Baltimore, MD, United States; Esther K. Chung, University of Washington School of Medicine, Seattle, WA, United States; Heather Burrows, University of Michigan Medical School, Ann Arbor, MI, United States; Sanghamitra M. Misra, Baylor College of Medicine, Houston, TX, United States

Background: Increasing matriculation of underrepresented in medicine (UIM) students has positive implications for access to quality care. Despite initiatives by institutions to foster an inclusive culture and build culturally adept communities, UIM learners continue to experience differential learning situations due to faculty biases and stereotype threats beyond the universal stressors of medical education. Black, Indigenous, and People of Color (BIPOC) medical students receive lower clinical assessments compared to non-BIPOC peers. Since BIPOC faculty representation remains low in medicine, the majority of today’s BIPOC learners are assessed by non-BIPOC, White faculty; predisposing medial students to potential bias based on their race/ethnicity.

Objective: To investigate the impact of faculty-student racial and ethnic discordance on pediatric medical student OSCE scoring.

Design/Methods: This IRB-exempt, multisite, cross-sectional study of pediatric faculty OSCE scoring used recordings of scripted OSCE scenarios by medical students from four different racial/ethnic backgrounds: White, Black, Hispanic, and Asian. Faculty were assigned to evaluate a racially/ethnically concordant video and a randomly assigned racially/ethnically discordant video. OSCEs were scored utilizing a 12-item Pediatric History Feedback tool to assess differences in scores between faculty and student concordant vs discordant encounters. A series of nonparametric Wilcoxon Signed-Rank and Wilcoxon Rank-Sum tests were used. A p-value less than 0.05 was considered statistically significant. Data was analyzed using SAS v9.4.

Results: Faculty participants across five academic institutions completed the study. Racial concordance between the faculty and student was associated with higher median scores for two of the 12 graded items - HPI p=0.0191) and ROS (p=0.0005), suggesting possible racial bias. Discordant pairs resulted in a higher median score only for the encounter closing (p=0.0273), suggesting possible reverse bias. When comparing White faculty (WF) to Non-White faculty (NWF), WF graded racially/ethnically concordant students higher on family history (p=0.0482) and social history (p=0.0003), while NWF graded Non-White students higher for the encounter closing (p=0.0123). There were no significant differences in the overall median OSCE score for racially/ethnically concordant and discordant pairs.

Conclusion(s): Despite relatively small sample size, there were statistically significant differences in scoring of some components of medical student OSCEs based on faculty-student racial/ethnic concordance and discordance.

Table 1: Sociodemographic Characteristics of Participants (N = 35)


Table 2: Observed Structure Clinical Examination Scores for all pairings based on faculty-student racial/ethnic concordance and discordance (N = 35)


Table 3: Observed Structure Clinical Examination Scores for concordant pairings only (i.e. White faculty-White student versus Non-White faculty-Non-White student)


Table 1: Sociodemographic Characteristics of Participants (N = 35)


Table 2: Observed Structure Clinical Examination Scores for all pairings based on faculty-student racial/ethnic concordance and discordance (N = 35)


Table 3: Observed Structure Clinical Examination Scores for concordant pairings only (i.e. White faculty-White student versus Non-White faculty-Non-White student)