The Interaction of Examinee's Ethnicity and Standardized Patient's Ethnicity: An Extended Analysis

Ethnicity poses a unique but serious question for assessments using standardized patients (SPs): Is there an interaction between examinees’ ethnicity and SPs’ ethnicity? With conventional examinations, this is not an issue because the examinee typically encounters only written, paper-and-pencil materials; however, with clinical-performance assessments, the examinee interacts with an SP, and their ethnicities are necessarily a part of the interaction. Thus, the concern for assessment is that examinees of a given ethnic background might be marked higher (or lower), depending upon the ethnic background of the SP. The usual concern is that examinees might perform and score better in encounters with SPs of the same ethnic background than they perform in encounters with SPs of different ethnicity. Naturally, if this were to occur, it would seriously undermine the validity of the examination scores, and worse, it could be indicative of an inherent and irreparable flaw in the SP-assessment approach. Despite the seriousness of this concern, to our knowledge, research has been limited to our recently published study. The problem is that most SP examinations do not have sufficient numbers of examinees and SPs of different ethnic backgrounds to make the necessary comparisons to conduct a study. We were able to address this important question by using data from the large-scale fourth-year assessment program involving medical students in the eight medical schools of the New York City Consortium. In that study, we compared the performances of white and black examinees in encounters with white SPs versus their performances in encounters with black SPs. Specifically, we were interested in whether examinees performed and scored better in encounters with SPs of the same ethnicity, as might be expected given their shared cultural backgrounds and the many things that implies. The results showed no pattern across the 24 analyses (involving different outcome measures, different cases, and two different classes) that would suggest any problem of an interaction between examinee ethnicity and SP ethnicity. Only three of the 24 interactions were statistically significant, and their results showed different patterns. One showed better examinees’ performances in encounters with SPs of the same ethnic background, consistent with what might be expected; however, the other two showed the opposite: better examinees’ performances in encounters with SPs of different ethnic backgrounds. In general, the results for all 24 interaction analyses showed only weak effects. The differences between white and black examinees were quite small regardless of the SPs’ ethnicity, and those differences were nearly identical for encounters with white SPs and those with black SPs, showing no interaction. The purpose of this study was to extend the analyses performed in our previous study by including data for a sizable group of Asian students. In our previous study, which focused on the comparison of performances of examinees with same and different ethnicities as the SPs, there were no Asian SPs, so the Asian students’ data were not used. There was no ‘‘same’’ condition for the Asian examinees’ data. The focus of the present study was the performances of Asian examinees in encounters with white and black SPs, which were compared with those of white and black examinees in encounters with the white and black SPs. Method