The sights and insights of examiners in objective structured clinical examinations

Abstract

PurposeThe objective structured clinical examination (OSCE) is considered to be one of the most robust methods of clinical assessment. One of its strengths lies in its ability to minimise the effects of examiner bias due to the standardisation of items and tasks for each candidate. However, OSCE examiners’ assessment scores are influenced by several factors that may jeopardise the assumed objectivity of OSCEs. To better understand this phenomenon, the current review aims to determine and describe important sources of examiner bias and the factors affecting examiners’ assessments.MethodsWe performed a narrative review of the medical literature using Medline. All articles meeting the selection criteria were reviewed, with salient points extracted and synthesised into a clear and comprehensive summary of the knowledge in this area.ResultsOSCE examiners’ assessment scores are influenced by factors belonging to 4 different domains: examination context, examinee characteristics, examinee-examiner interactions, and examiner characteristics. These domains are composed of several factors including halo, hawk/dove and OSCE contrast effects; the examiner’s gender and ethnicity; training; lifetime experience in assessing; leadership and familiarity with students; station type; and site effects.ConclusionSeveral factors may influence the presumed objectivity of examiners’ assessments, and these factors need to be addressed to ensure the objectivity of OSCEs. We offer insights into directions for future research to better understand and address the phenomenon of examiner bias.

<p>An evaluative study of objective structured clinical examination (OSCE): students and examiners perspectives</p>

“…As a result, the process was found to be very stressful and tiring for both the students and the examiners (most of the examiners move from one campus to another). It is a common realization that even in the formative and low-stakes settings, OSCEs were found to be an anxiety-inducing experience for students and a challenging and labor-intensive experience for the examiners and organizers 10–19. It was therefore conceptualized that any positive or negative perception on the implementation of the Medicine and Therapeutics exit OSCE may affect students’ anxiety and stress level as well as their performance in such a high stakes examination.…”

“…It was therefore conceptualized that any positive or negative perception on the implementation of the Medicine and Therapeutics exit OSCE may affect students’ anxiety and stress level as well as their performance in such a high stakes examination. Very few research studies have investigated the examiners perception of the OSCE process and on their role as examiners for this process 11,18,19. Examiners' opinions are required to be sought as examiners play a critical role in executing the OSCE, contribute to the design of the OSCE stations, identify the competences to be tested, and provide individual or group feedback to the students after examination 20.…”

Comparison of the effects of simulated patient clinical skill training and student roleplay on objective structured clinical examination performance among medical students in Australia

“…The assessment of communication skills involves real patients as well as SPs, and is generally delivered through objective structured clinical examinations (OSCEs) [12]. OSCEs have been established as the clinical assessment of choice in medicine, nursing, exercise physiology, physiotherapy, and other allied health programs and commonly examine multiple skillsets simultaneously.…”

Improving the Quality of Evaluation Data in Simulation-Based Healthcare Improvement Projects

“…However, being task-agnostic means that GRSs can be more susceptible to the halo effect (than checklists, for example), resulting in an increased likelihood of similar responses across items, which may artificially inflate the tool's internal consistency. 36 , 37 It is also worth noting that a GRS is sometimes embedded within a behavioral marker system. For example, the Objective Structured Assessment of Technical Skills 38 contains both a behavioral marker checklist and a multi-item GRS; and the Team Emergency Assessment Measure 39 contains a series of behavioral marker rating scales followed by a single-item GRS to capture impressions of overall nontechnical performance.…”