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The effect of a brief social intervention on the examination results of UK medical students: a cluster randomised controlled trial

Open access
Woolf, Katherine, McManus, I Chris, Gill, Deborah, Dacre, Jane·2009·BMC Medical Education
DOI 10.1186/1472-6920-9-35PMC PMC2717066
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Abstract

BACKGROUND: Ethnic minority (EM) medical students and doctors underperform academically, but little evidence exists on how to ameliorate the problem. Psychologists Cohen et al. recently demonstrated that a written self-affirmation intervention substantially improved EM adolescents' school grades several months later. Cohen et al.'s methods were replicated in the different setting of UK undergraduate medical education. METHODS: All 348 Year 3 white (W) and EM students at one UK medical school were randomly allocated to an intervention condition (writing about one's own values) or a control condition (writing about another's values), via their tutor group. Students and assessors were blind to the existence of the study. Group comparisons on post-intervention written and OSCE (clinical) assessment scores adjusted for baseline written assessment scores were made using two-way analysis of covariance. All assessment scores were transformed to z-scores (mean = 0 standard deviation = 1) for ease of comparison. Comparisons between types of words used in essays were calculated using t-tests. The study was covered by University Ethics Committee guidelines. RESULTS: Groups were statistically identical at baseline on demographic and psychological factors, and analysis was by intention to treat [intervention group EM n = 95, W n = 79; control group EM n = 77; W n = 84]. As predicted, there was a significant ethnicity by intervention interaction [F(4,334) = 5.74; p = 0.017] on the written assessment. Unexpectedly, this was due to decreased scores in the W intervention group [mean difference = 0.283; (95% CI = 0.093 to 0.474] not improved EM intervention group scores [mean difference = -0.060 (95% CI = -0.268 to 0.148)]. On the OSCE, both W and EM intervention groups outperformed controls [mean difference = 0.261; (95%CI = -0.047 to -0.476; p = 0.013)]. The intervention group used more optimistic words (p < 0.001) and more "I" and "self" pronouns in their essays (p < 0.001), whereas the control group used more "other" pronouns (p < 0.001) and more negations (p < 0.001). DISCUSSION: Cohen et al.'s finding that a brief self-affirmation task narrowed the ethnic academic achievement gap was replicated on the written assessment but against expectations, this was due to reduced performance in the W group. On the OSCE, the intervention improved performance in both W and EM groups. In the intervention condition, participants tended to write about themselves and used more optimistic words than in the control group, indicating the task was completed as requested. The study shows that minimal interventions can have substantial educational outcomes several months later, which has implications for the multitude of seemingly trivial changes in teaching that are made on an everyday basis, whose consequences are never formally assessed.

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  • The evaluative and public nature of the activity in the Woolf et al. (2009) study may have compromised its ability to be affirming.

    “Beyond unblinding instructors to students' condition assignment, the evaluative and public nature of the activity may have compromised its ability to be affirming.”

    From The Psychology of Change: Self-Affirmation and Social Psychological Intervention (2014) · cites this paper as Woolf et al. 2009

    The Methods (Procedures and Interventions; page unavailable) say tutors marked the reflective exercises and selected a few submissions for discussion in tutorials, supporting the description of the activity as evaluative and potentially public. The paper does not say that these features may have compromised the activity’s ability to be affirming; that is the citing authors’ interpretation. (LLM, conf=0.83)

    Experimental — accuracy not yet measured

  • In the Woolf et al. (2009) study, it was unclear whether identity threat contributed to the performance of the ethnic minority sample.

    “First, it was unclear whether identity threat contributed to the performance of the ethnic minority sample, a heterogeneous group consisting primarily of Asian Indian, Pakistani, and Bangladeshi participants.”

    From The Psychology of Change: Self-Affirmation and Social Psychological Intervention (2014) · cites this paper as Woolf et al. 2009

  • In the Woolf et al. (2009) study, procedural changes made the affirmation evaluative in nature.

    “Second, procedural changes made the affirmation evaluative in nature.”

    From The Psychology of Change: Self-Affirmation and Social Psychological Intervention (2014) · cites this paper as Woolf et al. 2009

  • Another affirmation intervention with an ethnically heterogeneous sample of medical students in England found mixed effects, improving the performance of all students on their clinical evaluations and undermining the performance of white students on a written examination.

    “Another affirmation intervention with an ethnically heterogeneous sample of medical students in England found mixed effects, improving the performance of all students on their clinical evaluations and undermining the performance of white students on a written examination(Woolf et al. 2009).”

    From The Psychology of Change: Self-Affirmation and Social Psychological Intervention (2014) · cites this paper as Woolf et al. 2009

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Research works printed but not linked: 2

  1. Xu G Veloski JJ Hojat M Gonnella JS Bacharach B Longitudinal comparison of the academic performances of Asian-American and white medical students Acad Med 1993 68 82 6 8447898
  2. Kerry SM Bland JM Sample size in cluster randomisation BMJ 1998 316 549 9501723 PMC2665662

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Authors
Woolf, K., McManus, I. C., Gill, D., & Dacre, J.
Affiliations
University College London (GB)
Corresponding author
Woolf, Katherine
ORCID
Venue
BMC Medical Education
Publisher
Springer Science and Business Media LLC
Published
2009-06-24
Volume
9
Issue
1
Pages
35-35
ISSN
1472-6920 (ISSN-L)
DOI
10.1186/1472-6920-9-35
PMC
PMC2717066
OpenAlex
W2027182423
Cited by
37
References
39
Citations by year
2025: 2 · 2024: 1 · 2023: 2 · 2022: 2 · 2021: 4 · 2020: 12 · 2019: 2 · 2018: 2 · 2016: 2 · 2014: 2 · 2012: 3
FWCI
2.02
Type
journal article
Language
en
Open access
Licence
Locations
  • BMC Medical Education (publishedVersion, cc-by)
  • PubMed Central (publishedVersion, cc-by)
  • PubMed (publishedVersion)
  • ePrints Soton (University of Southampton) (acceptedVersion)
  • DOAJ (DOAJ: Directory of Open Access Journals) (submittedVersion)
  • UCL Discovery (University College London) (submittedVersion)
Topics
  • Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Innovations in Medical Education
  • Social Sciences › Gender Studies › Diversity and Career in Medicine
  • Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Medical Education and Admissions
Keywords
self-affirmation intervention, academic performance, medical education, written assessment, OSCE assessment, optimism, values affirmation, self-concept, self-efficacy
MeSH terms
Analysis of Variance, Curriculum, Educational Measurement, Educational Status, Ethnicity, United Kingdom, Humans, Psychology, Self Concept, Social Perception, Students, Medical, Cluster Analysis, Models, Educational

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