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Research The inf luence of ethnicity on assessments and academic progression in a midwifery degree Abstract Background/Aims Midwifery degrees require students to study for 3 years, during which they are assessed both academically and in practice placements. This study’s aim was to explore year-by-year associations between assessment grades and students’ ethnicity as they progressed through their degree. Methods Retrospective data collected at a single university in the UK were analysed using descr iptive statistics. The cohort and var iables were stratified by student ethnicity, year of study and assessment grades given for academic work and placement practice assessments. Results While Black, Asian and minority ethnic students started with lower practice assessment grades in year 1, this improved such that there was no difference in attainment by year 3. In contrast, university academic grades were consistently lower for Black, Asian and minority ethnic versus White students, and this pattern did not change throughout the degree programme. Conclusions The likely factor in lower final degree outcomes among Black, Asian and minority ethnic students is not from practice assessments but academic performance. Targeted interventions that recognise different learning styles and educational experiences in the university environment may address and improve this inequality in attainment. Key words Assessment outcomes  |  Awarding gap  |  Ethnicity  |  Placement  |  Student midwife Shauna Gnanapragasam Senior lecturer, Faculty of Health, Education and Medicine, Anglia Ruskin University shauna.gnanapragasam@aru.ac.uk The student population in higher education is becoming more ethnically diverse. Since 2003/2004, the proportion of White students has been steadily decreasing alongside a year-on-year increase of those identifying as Black, Asian and minority ethnic (Advance Higher Education (AHE), 2022). However, it is widely documented across all sectors that Black, Asian and minority ethnic students are less likely to achieve final first class/2:1 degrees at UK universities than their White counterparts (Gov.uk, 2022, AHE, 2022). Over recent years, the UK government has demanded improvements to do more to close the gap in final grades. Reasons for the gap are multifactor ial and are likely to include structural, organisational, financial and cultural attitudes (Singh, 2011; AHE, 2022). The ‘closing the gap’ report (Universities UK and National Union of Students, 2019) highlighted that there is an urgency to improve the curr iculum of all university courses to address issues of diversity, equality and discr imination. Midwifery educators and stakeholders are being urged to decolonise midwifery education by removing the Eurocentr ic lens that currently dominates most curr iculums (Royal College of Midwives (RCM), 2023). Although some headway may have been made in addressing these issues, there are concerns that interventions to address the current dispar ity are predominantly university campus based (Nightingale et al, 2022). However, over their degree programme, midwifery students spend lear ning time in both the placement area and the university setting (Nursing and Midwifery Council (NMC), 2019). Grades awarded in both areas can contr ibute to a student’s final degree classification at the end of the programme, and both are therefore essential to understanding attainment gaps.The practice-based assessment requires students to integrate their skills and knowledge into clinical practice. As the student gathers exper ience, they are evaluated by midwives with assessor status (NMC, 2018; 2019). Histor ically, it has been reported that assessment grades awarded by healthcare professionals in the td Healthcare L 2024 MA © 58 British Journal of Midwifer y, Februar y 2024, Vol 32, No 2
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Research placement area can be var iable (Alpine et al, 2021). Between 2018 and 2019, the NMC (2019) reported that 90% of midwives working the UK identified as White, 4% as Black and 6% of another ethnicity. The lack of diversity in the workforce is known to contr ibute to dispar ities in maternal health (Knight et al, 2021). Recommendations are in place from professional bodies involved in maternity care to raise awareness of the explicit and implicit racial bias that exists; the NMC (2021), RCM (2023) and the Royal College of Obstetr icians and Gynaecologists (2023) address negative stereotypes and beliefs about race, and how these impact the care provided to women. Despite this, nurses and midwives continue to exper ience racism in practice (Ford, 2021) and students are thus likely to have similar exper iences.What remains unknown is ‘how’ or indeed ‘if ’ ethnicity impacts assessment outcomes for midwifery students when in placement, who are being assessed by a predominantly White workforce. The preliminary findings of the author’s wider doctorate work (in press at the time of writing) identified that ethnicity has a significant impact on final degree attainment, with Black, Asian and minority ethnic students being much less likely to achieve the highest grades compared to White students. However, it is unknown if this is true throughout the degree programme and which part of the midwifery student assessment contr ibutes to this phenomenon. Better understanding of student performance as they progress through the course, and specifically how they are marked and assessed in their practice placements (which is largely outside university oversight), may identify where key interventions are needed to ensure equitable and fair assessment for all. This study explored whether the attainment gap in final grades was the result of Black, Asian and minority ethnic students not performing as well as White counterparts in practice placement settings. td Healthcare L 2024 MA © Te r m i n o l o g y The term Black, Asian and minority ethnic has been used in this research. However, it is acknowledged that there are challenges in using homogenous language. Black, Asian and minority ethnic is a term that can be seen as too general and groups together all those who are Black, Asian and minority ethnic Br itish. No disrespect or offence is intended, and it is acknowledged that language and terminology will evolve beyond publication of this work. Methods A retrospective cohort observation study was car r ied out at a UK university in the south of England. The sample included all students who entered the BSc (Hons) 3-year midwifery programme between 2014 and 2018. Data collection Anonymised data were retr ieved from the university student record system, which tracks each individual student journey from the point of admission to the course through to graduation. Over the 5-year per iod, 332 students were enrolled, with those who completed the degree included in the analysis (n=248).Two further students were removed from the dataset, as one had missing assessment outcome data and another had not disclosed ethnicity. The main outcome measures used for this study were yearly university assessment grades and practice-based assessment grades. The university grade was der ived from a 30-credit written assessment anonymously marked and moderated by university lecturers. The practice‑based assessment grade was der ived from a practice assessment document graded in practice by registered midwives. Data ana lysis The practice assessment document was graded by midwives in practice with a holistic assessment descr iptor. The descr iptors for overall student performance ranged from ‘excellent’ to ‘unsatisfactory’. Each descr iptor had a percentage mark attached to it, which was the mark awarded for the assessment. The following system was used: ≥70% was categor ised as first class, 60–69% was a 2:1, 50–59% was a 2:2, 40–49% was a third class. Statistical comparisons were done using the Statistical Package for Social Sciences programme (version 29) through Chi‑squared analysis, with P<0.05 used to indicate significance. Ethical considerations Ethical approval was granted from the University School Research Ethics Panel (approval number: ESC‑SREP-21-094) to explore entry route, student demographics and final degree outcomes in the cohort of students. To explore specific assessment outcomes, the university Research Ethics Panel was approached following initial findings (in press) for a significant amendment to the initial application. Approval was granted (approval number: ETH2223-10509). The ethics panel did not require individual consent to be obtained from the students, because of the size and nature of the study. Results Cohort demographics A total of 246 students were included in the analysis, with 192 identifying as White, 29 identifying as Black British Journal of Midwifer y, Februar y 2024, Vol 32, No 2 59

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Research

The inf luence of ethnicity on assessments and academic progression in a midwifery degree

Abstract Background/Aims Midwifery degrees require students to study for 3 years, during which they are assessed both academically and in practice placements. This study’s aim was to explore year-by-year associations between assessment grades and students’ ethnicity as they progressed through their degree. Methods Retrospective data collected at a single university in the UK were analysed using descr iptive statistics. The cohort and var iables were stratified by student ethnicity, year of study and assessment grades given for academic work and placement practice assessments. Results While Black, Asian and minority ethnic students started with lower practice assessment grades in year 1, this improved such that there was no difference in attainment by year 3. In contrast, university academic grades were consistently lower for Black, Asian and minority ethnic versus White students, and this pattern did not change throughout the degree programme. Conclusions The likely factor in lower final degree outcomes among Black, Asian and minority ethnic students is not from practice assessments but academic performance. Targeted interventions that recognise different learning styles and educational experiences in the university environment may address and improve this inequality in attainment.

Key words Assessment outcomes  |  Awarding gap  |  Ethnicity  |  Placement  |  Student midwife

Shauna Gnanapragasam Senior lecturer, Faculty of Health, Education and Medicine, Anglia Ruskin University shauna.gnanapragasam@aru.ac.uk

The student population in higher education is becoming more ethnically diverse. Since 2003/2004, the proportion of White students has been steadily decreasing alongside a year-on-year increase of those identifying as Black, Asian and minority ethnic (Advance Higher Education (AHE), 2022). However, it is widely documented across all sectors that Black, Asian and minority ethnic students are less likely to achieve final first class/2:1 degrees at UK universities than their White counterparts (Gov.uk, 2022, AHE, 2022).

Over recent years, the UK government has demanded improvements to do more to close the gap in final grades. Reasons for the gap are multifactor ial and are likely to include structural, organisational, financial and cultural attitudes (Singh, 2011; AHE, 2022). The ‘closing the gap’ report (Universities UK and National Union of Students, 2019) highlighted that there is an urgency to improve the curr iculum of all university courses to address issues of diversity, equality and discr imination. Midwifery educators and stakeholders are being urged to decolonise midwifery education by removing the Eurocentr ic lens that currently dominates most curr iculums (Royal College of Midwives (RCM), 2023).

Although some headway may have been made in addressing these issues, there are concerns that interventions to address the current dispar ity are predominantly university campus based (Nightingale et al, 2022). However, over their degree programme, midwifery students spend lear ning time in both the placement area and the university setting (Nursing and Midwifery Council (NMC), 2019). Grades awarded in both areas can contr ibute to a student’s final degree classification at the end of the programme, and both are therefore essential to understanding attainment gaps.The practice-based assessment requires students to integrate their skills and knowledge into clinical practice. As the student gathers exper ience, they are evaluated by midwives with assessor status (NMC, 2018; 2019).

Histor ically, it has been reported that assessment grades awarded by healthcare professionals in the td

Healthcare L

2024 MA

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British Journal of Midwifer y, Februar y 2024, Vol 32, No 2

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