This study employed two distinct methodologies: 18 months of participant observation whilst working as a nurse and invited observations of episodes of skilled behaviour followed by knowledge interviews using heuristic devices as mediating artefacts. Access to the ward and invitations to observe (with patient consent) were granted in return for free labour between episodes and whenever the ward was exceptionally busy. The ethnographic data was analysed using Strauss’s paradigm analysis; the resultant accounts of ward activities, culture and performance were checked by participants. Two forms of mediating artefact were used to facilitate knowledge elicitation interviews and the co‐construction with practitioners of representations of their expertise. The first was a small knowledge map linking scientific knowledge to nursing interventions and processes, sketched immediately after observation; this followed the format developed by Eraut. The second was a sequence of digital photographs taken during the episode itself, subject to immediate censorship by the patient. Post‐interview accounts of the episode, supplemented by revised maps and relevant photographs, were checked by the practitioner on the following day. The 52 accounts were then analysed according to type of task, degree of fluency, use of deliberation, nurse’s levels of experience, situational recognition and degree of guidance provided by anticipated outcomes. The dual methodology provides a unique perspective on factors affecting access to learning opportunities and the relationship between individuals learning and transactions within the context of everyday practice. Subsequent publications will further discuss the progressive development of nursing expertise, illustrating the following: the role of disposition towards learning of capable practitioners; whether learning was facilitated or constrained by the system of work allocation on the ward; learning and individual dispositions towards the constraints of context, and the role of historical camps, loyalties and allegiances in promoting domain traditions in nursing work.

Introduction This study aimed to explore the decision-making processes of raters during objective structured clinical examinations (OSCEs), in particular to explore the tacit assumptions and beliefs of raters as well as rater idiosyncrasies. Methods Thinking aloud protocol interviews were used to gather data on the thoughts of examiners during their decision-making, while watching trigger OSCE videos and rating candidates. A purposeful recruiting strategy was taken, with a view to interviewing both examiners with many years of experience (greater than six years) and those with less experience examining at final medical examination level. Results Thirty-one interviews were conducted in three centres in three different countries. Three themes were identified during data analysis, entitled ‘OSCEs are inauthentic’, ‘looking for glimpses of truth’ and ‘evolution with experience’. Conclusion Raters perceive that the shortcomings of OSCEs can have unwanted effects on student behaviour. Some examiners, more likely the more experienced group, may deviate from an organisations directions due to perceived shortcomings of the assessment. No method of assessment is without flaw, and it is important to be aware of the limitations and shortcomings of assessment methods on student performance and examiner perception. Further study of assessor and student perception of OSCE performance would be helpful.

This paper describes a study of the progression of qualified surgical nurses towards capable proficiency in one setting using participant observation within an ethnographic approach. Two distinct methodologies were used: (i) 18 months of participant observation of the social and economic processes that shaped the nursing team, its leadership and a busy surgical practice context, in which qualified nurses and post‐qualifiers learned the ropes of the specialty; and (ii) invited observations of episodes of skilled behaviour followed by knowledge elicitation interviews using heuristic devices as mediating artefacts. These artefacts, digital images and practitioner knowledge maps allowed the individual to explore current and potential representations of their knowledge within a variety of contexts. Distinctions were drawn between the features of fluent and problem‐solving activity, and factors that triggered an interruption in clinical fluency were isolated. Deliberative triggers and outcomes were analysed by the practitioner. Establishing the cadre of local fluent capability within the ward presented the opportunity to explore newcomer progression. The dual methodology provided a unique perspective on: (i) the context of capability and progression towards clinical nursing fluency; (ii) the different role of deliberation in capable and newcomer practice, and (iii) an emergent view of newly promoted senior nurses as they learned to run things in the ward. This view of using management knowledge differs from the type of knowledge use revealed in clinical fluency. This leads to a theoretical analysis of how different kinds of skills are learned and the relationship between individual and social aspects of learning.

Introduction This study aimed to explore the decision-making processes of raters during objective structured clinical examinations (OSCEs), in particular to explore the tacit assumptions and beliefs of raters as well as rater idiosyncrasies.MethodsThinking aloud protocol interviews were used to gather data on the thoughts of examiners during their decision-making, while watching trigger OSCE videos and rating candidates. A purposeful recruiting strategy was taken, with a view to interviewing both examiners with many years of experience and those with less experience examining at final medical examination level.ResultsThirty-one interviews were conducted in three centres in three different countries. Three themes were identified during data analysis, entitled ‘OSCEs are inauthentic’, ‘looking for glimpses of truth’ and ‘evolution with experience’. ConclusionThis study gives an insight into how raters approach OSCEs, and how the perceived shortcomings of OSCEs affect how examiners consider candidate behaviours. Some examiners, more likely the more experienced group, may deviate from an organisation’s instructions due to perceived shortcomings of the assessment.

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