Race and Ethnicity in UK Medical Licensing Assessment Single Best Answer Questions: Ethical, Psychometric and Methodological Considerations

Abstract

 Single best answer (SBA) questions dominate UK medical licensing assessments, valued for their standardisation, reliability, and psychometric rigour. Yet the inclusion of demographic descriptors, particularly race and ethnicity, raises ethical and methodological challenges. Evidence indicates that presenting race or ethnicity in the opening sentence of an SBA stem may trigger cognitive biases, reinforce stereotypes, and introduce construct-irrelevant variance, potentially compromising fairness and validity. This perspective critically examines the use of race and ethnicity in UK licensing SBAs, emphasising that such descriptors should be included only when clinically relevant and embedded within the clinical observation or context rather than as initial identifiers. We propose a framework to guide item writers, aligning with international best practice and psychometric principles, to ensure ethical, unbiased assessment. By implementing these recommendations, the UK Medical Licensing Assessment can enhance construct validity, reduce bias, and promote equity, setting a precedent for ethically sound and psychometrically robust medical examinations.