Adapted from work by Celia Roberts Professor of Linguistics at Kings College, London.

Adapted from work by Celia Roberts

Professor of Linguistics at Kings College ,London

Cause for concern: the ‘under performance’ of minority ethnic candidates

Can social theory help us understand these complex factors?

Simulations Linguistic capital : Examples of problems Evaluation of failed candidates Conclusions

Ethnicity◦ Pass rates for white candidates 93.6%◦ Pass rates for ethnic minorities (all) 68%

Country of Graduation◦ UK 91.6%◦ EEA 72%◦ Non European 56.9%

Ethnicity◦ White 93%◦ Asian 74.1%◦ Black 64.5%

Country Of Graduation◦ UK 90.9%◦ EEA 65.2%◦ IMGs 70.3%

It isn’t as simple as “command of English”

Self-reporting of first language other than English is surprisingly low

‘Place of graduation’ packages up many factors all of which may inter-relate

Pierre Bourdieu

Concept of ‘habitus’

Products of early opportunities and constraints, particularly early socialisation within the family.

Cultural, social and linguistic capital

Those in power have more of this symbolic capital

The ‘fish in water’

Overseas graduates least likely to have acquired it

British working class and ethnic minority groups are less likely to be socialised into this form of linguistic capital.

Those whose habitus has prevented them from acquiring the dominant linguistic capital will have ‘less feel for the game’. Its harder to be ‘a fish in water’

Du Bois’ notion of ‘Double Consciousness’ among minority ethnic professionals: compartmentalisation , maintaining distinct cultural spheres

Impact on simulated consulting

Additional pressure on those who have relatively less ‘linguistic capital’ and so less ‘feel for the game’

The ‘double consciousness’ of IMG candidates – where have a double simulation, particularly in those areas of sensitivity and empathy which are crucial to being successful in the CSA.

Those with a ‘feel for the game’ will have the capacity to be ‘hyper –real’ in order to play to the examiner.

It is possible that the CSA puts more pressure on non middle class EM candidates and those who graduated abroad than the old style consulting skills exam of real consultations

Over-modelling◦Result of required ideological shift and

lack of support to do so◦Recipe –like, formulaic, the ‘bones

showing through the flesh’

Over direct and/or formulaic, very little mitigation or hedging

D: Did you know why we did the X-ray? Too much direct questioning to elicit

expectations/concerns D: Is there anything particularly worrying

you ? (When the patient has already expressed her worries)

No immediate listening to patient’s concerns P: Ive had heart problems and I was told to

come in to-day D: Just going through your medical records,

you have been hypertensive for some time.

Patient given bad news that may have cancer

And how does that make you feel? Patient shakes his head and shrugs his

shoulders What do you think about it, are you happy

for me to refer you? I don’t feel happy about anything What are you not happy about?

Overly Categorising

◦ this is a high risk pregnancy without mitigating

the bad news – (no sunny pairing)

◦ Lets talk about your obesity

1. Does not develop appropriate management plan. (Unsurprising since the development of management plan draws on the whole consultation)

2. Does not develop shared management plan3. Does not identify patients’ agenda/preferences or

make use of cues4. Does not recognise the challenge5. Too Dr-centered6. Does not use relevant and understandable

explanations7. Disorganised and unsystematic gathering of

information

Frequent comments about the evidence of weak candidates’ interpersonal skills:◦ Eye contact◦ Didn’t ask open questions

Being formulaic and interrogative

Unable to explain effectively

But none of these in isolation account for the way the whole interaction is going. They are often proxies for more subtle features

Not easy to categorise why CSA so challenging for this group

Need to find ways of helping students to develop an appropriate habitus and linguistic capital at the undergraduate and training levels

Develop an analytic language and ways of supporting those on preparation and re-sit courses by working on the detailed ways of realising the positive generic indicators.

Emphasis on listening, relating and a more organic mode of interacting Background the models

Acknowledge the challenges of the double simulation for many minority ethnic group candidates and provide opportunities for plenty of practice.