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Student perspectives on barriers to performance for black and minority ethnic graduate-entry medical students: a qualitative study in a West Midlands medical school
  1. Nariell Morrison,
  2. Michelle Machado,
  3. Clare Blackburn
  1. Division of Health Sciences, Warwick Medical School, University of Warwick, Coventry, West Midlands, UK
  1. Correspondence to Nariell Morrison; n.morrison{at}


Objective To explore graduate-entry medical students experiences of undergraduate training in the context of academic underperformance of medical students from ethnic minority backgrounds.

Design Qualitative study using semi-structured focus groups.

Setting A West Midlands medical school.

Participants 24 graduate-entry MBChB students were recruited using volunteer and snowball sampling; all students self-identified as being from Black and Minority Ethnic (BME) backgrounds.

Results BME students reported facing a range of difficulties, throughout their undergraduate medical training, that they felt impeded their learning and performance. Their relationships with staff and clinicians, though also identified as facilitators to learning, were also perceived to have hindered progress, as many students felt that a lack of BME representation and lack of understanding of cultural differences among staff impacted their experience. Students also reported a lack of trust in the institution’s ability to support BME students, with many not seeking support. Students’ narratives indicated that they had to mask their identity to fit in among their peers and to avoid negative stereotyping. Although rare, students faced overt racism from their peers and from patients. Many students reported feelings of isolation, reduced self-confidence and low self-esteem.

Conclusions BME students in this study reported experiencing relationship issues with other students, academic and clinical staff, lack of trust in the institution and some racist events. Although it is not clear from this small study of one institution whether these findings would be replicated in other institutions, they nevertheless highlight important issues to be considered by the institution concerned and other institutions. These findings suggest that all stakeholders of graduate-entry undergraduate medical education should reflect on the current institutional practices intended to improve student–peer and student–staff relationships. Reviewing current proposals intended to diversify student and staff populations as well as evaluating guidance on tackling racism is likely to be beneficial.

  • undergraduate
  • medical education
  • qualitative research
  • diversity
  • ethnicity

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  • Contributors NM: conceived of the research project which was further developed with MM and CB; analysed the data under the supervision of MM and CB; wrote the first draft of the article and all authors revised it critically for important intellectual content. NM, CB and MM: designed the research project. NM, with MM and CB: interpreted the data. NM and CB: revised the draft paper. All authors approved of the final version to be published. NM is the guarantor.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Patient consent for publication Not required.

  • Ethical approval Ethical approval was granted by The University of Warwick Biomedical and Scientific Research Ethics Committee August 2018 (REGO-2018-2244).

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Data availability statement All data relevant to the study are included in the article or uploaded as supplementary information.