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Brown C, Khavandi S, Sebastian A, Badger K, Westacott R, Reed MWR, Gurnell M, Sam AH. The influence of candidates' race on examiners' ratings in standardised assessments of clinical practice. MEDICAL TEACHER 2024:1-6. [PMID: 38771961 DOI: 10.1080/0142159x.2024.2345266] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/03/2023] [Accepted: 04/16/2024] [Indexed: 05/23/2024]
Abstract
PURPOSE Delivering fair and reliable summative assessments in medical education assumes examiner decision making is devoid of bias. We investigated whether candidate racial appearances influenced examiner ratings in undergraduate clinical exams. METHODS We used an internet-based design. Examiners watched a randomised set of six videos of three different white candidates and three different non-white (Asian, black and Chinese) candidates taking a clinical history at either fail, borderline or pass grades. We compared the median and interquartile range (IQR) of the paired difference between scores for the white and non-white candidates at each performance grade and tested for statistical significance. RESULTS 160 Examiners participated. At the fail grade, the black and Chinese candidates scored lower than the white candidate, with median paired differences of -2.5 and -1 respectively (both p < 0.001). At the borderline grade, the black and Chinese candidates scored higher than the white candidate, with median paired differences of +2 and +3, respectively (both p < 0.001). At the passing grade, the Asian candidate scored lower than the white candidate (median paired difference -1, p < 0.001). CONCLUSION The racial appearance of candidates appeared to influence the scores awarded by examiners, but not in a uniform manner.
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Affiliation(s)
- Celia Brown
- Division of Health Sciences, Warwick Medical School, Coventry, UK
| | - Sarah Khavandi
- Imperial College School of Medicine, Imperial College London, London, UK
| | - Ann Sebastian
- Imperial College School of Medicine, Imperial College London, London, UK
| | - Kerry Badger
- Imperial College School of Medicine, Imperial College London, London, UK
| | - Rachel Westacott
- Birmingham Medical School, University of Birmingham, Birmingham, UK
| | - Malcolm W R Reed
- Brighton and Sussex Medical School, University of Sussex, Brighton, UK
| | - Mark Gurnell
- Wellcome-MRC Institute of Metabolic Science, University of Cambridge and NIHR Cambridge Biomedical Research Centre, Cambridge University Hospitals, Cambridge, UK
| | - Amir H Sam
- Imperial College School of Medicine, Imperial College London, London, UK
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Schauber SK, Olsen AO, Werner EL, Magelssen M. Inconsistencies in rater-based assessments mainly affect borderline candidates: but using simple heuristics might improve pass-fail decisions. ADVANCES IN HEALTH SCIENCES EDUCATION : THEORY AND PRACTICE 2024:10.1007/s10459-024-10328-0. [PMID: 38649529 DOI: 10.1007/s10459-024-10328-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/20/2023] [Accepted: 03/24/2024] [Indexed: 04/25/2024]
Abstract
INTRODUCTION Research in various areas indicates that expert judgment can be highly inconsistent. However, expert judgment is indispensable in many contexts. In medical education, experts often function as examiners in rater-based assessments. Here, disagreement between examiners can have far-reaching consequences. The literature suggests that inconsistencies in ratings depend on the level of performance a to-be-evaluated candidate shows. This possibility has not been addressed deliberately and with appropriate statistical methods. By adopting the theoretical lens of ecological rationality, we evaluate if easily implementable strategies can enhance decision making in real-world assessment contexts. METHODS We address two objectives. First, we investigate the dependence of rater-consistency on performance levels. We recorded videos of mock-exams and had examiners (N=10) evaluate four students' performances and compare inconsistencies in performance ratings between examiner-pairs using a bootstrapping procedure. Our second objective is to provide an approach that aids decision making by implementing simple heuristics. RESULTS We found that discrepancies were largely a function of the level of performance the candidates showed. Lower performances were rated more inconsistently than excellent performances. Furthermore, our analyses indicated that the use of simple heuristics might improve decisions in examiner pairs. DISCUSSION Inconsistencies in performance judgments continue to be a matter of concern, and we provide empirical evidence for them to be related to candidate performance. We discuss implications for research and the advantages of adopting the perspective of ecological rationality. We point to directions both for further research and for development of assessment practices.
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Affiliation(s)
- Stefan K Schauber
- Centre for Health Sciences Education, Faculty of Medicine, University of Oslo, Oslo, Norway.
- Centre for Educational Measurement (CEMO), Faculty of Educational Sciences, University of Oslo, Oslo, Norway.
| | - Anne O Olsen
- Department of Community Medicine and Global Health, Institute of Health and Society, University of Oslo, Oslo, Norway
| | - Erik L Werner
- Department of General Practice, Institute of Health and Society, University of Oslo, Oslo, Norway
| | - Morten Magelssen
- Centre for Medical Ethics, Institute of Health and Society, University of Oslo, Oslo, Norway
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Brown CA, Badger K, Reid MD, Westacott R, Gurnell M, Reed MWR, Chamberlain G, Hatfield E, Sharif A, Sam AH. The influence of candidates' physical attributes on patient ratings in simulated assessments of clinical practice. MEDICAL TEACHER 2022; 44:1277-1282. [PMID: 35820076 PMCID: PMC9612930 DOI: 10.1080/0142159x.2022.2093177] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
BACKGROUND We have previously shown that clinical examiners' scoring is not negatively impacted when a candidate has a tattoo, unnatural hair colour, or a regional accent. We investigated whether these physical attributes in exam candidates impact patient scoring. METHODS Simulated/real patients were randomly assigned to watch five videos of simulated candidate performances of a cranial nerve examination: clear fail, borderline, good, 'clear pass' without an attribute, and 'clear pass' with one of the attributes (tattoo, purple hair, accent). Participants scored domains of communication and professionalism. We compared scores for the clear pass candidates with and without attributes. RESULTS One hundred and eighty three patients participated. The total scores for the candidates with tattoos and purple hair were higher than the candidate with no physical attribute (p < 0.001). For the candidate with a Liverpool English accent no difference was identified (p = 0.120). CONCLUSIONS The presence of certain physical attributes (tattoos or purple hair) was associated with higher scores given by patients to candidates in a simulated physical examination station.
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Affiliation(s)
- C. A. Brown
- Division of Health Sciences, Warwick Medical School, Coventry, UK
| | - K. Badger
- Imperial College School of Medicine, Imperial College London, London, UK
| | - M. D. Reid
- Imperial College School of Medicine, Imperial College London, London, UK
| | - R. Westacott
- Birmingham Medical School, University of Birmingham, Birmingham, UK
| | - M. Gurnell
- Wellcome–MRC Institute of Metabolic Science, University of Cambridge and NIHR Cambridge Biomedical Research Centre, Cambridge University Hospitals, Cambridge, UK
| | - M. W. R. Reed
- Brighton and Sussex Medical School, University of Sussex, Brighton, UK
| | - G. Chamberlain
- Imperial College School of Medicine, Imperial College London, London, UK
| | - E. Hatfield
- Imperial College School of Medicine, Imperial College London, London, UK
| | - A. Sharif
- Imperial College School of Medicine, Imperial College London, London, UK
| | - A. H. Sam
- Imperial College School of Medicine, Imperial College London, London, UK
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Régent A, Arlet JB, Cheminet G, Pouchot J, Mouthon L, Le Jeunne C. [Contribution and limits of "OSCE", "long-case" and "global end-of-placement marking" as end-of-rotation assessment methods. Experience from two internal medicine wards]. Rev Med Interne 2022; 43:581-588. [PMID: 36089428 DOI: 10.1016/j.revmed.2022.07.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2022] [Revised: 07/11/2022] [Accepted: 07/27/2022] [Indexed: 11/18/2022]
Abstract
INTRODUCTION During placements, there is an opportunity to learn clinical skills and to assess their application. However, it represents two different goals. The validity of an end-of-placement assessment is questionable, as the medical competency is contextual. We decided to evaluate the contribution and limits of different assessment modalities as an end-of-placement assessment. MATERIAL AND METHODS Internal medicine clerks were assessed using the Mini-Cex grid by a structured objective clinical examination (OSCE), a long-case clinical examination (LCE) and a global end-of-placement marking (GEPM). Following these evaluations, students and teachers fulfilled an open questionnaire. RESULTS In 2021, 41 students and 16 teachers participated in the study. Physical examination was evaluated in 0%, 97% et 76% of cases during OSCE, LCE and GEPM, respectively; teaching skills were assessed for 100, 42 et 49% of students in OSCE, LCE and GEPM, respectively. As compared to OSCE, there was a perceived superiority of LCE regarding its formative value (P=0.07 and P=0.03) and its summative value (P=0.0007 and P=0.02), for students and teachers, respectively. Qualitative analysis highlights the breadth of clinical skills that could be assessed during OSCE stations. Integration into a team was an additional skill that could specifically be assessed during GEPM. GEPM could also take into account the progress made during placement. CONCLUSION Despite its subjectivity, LCE seemed to be the preferred modality for an end-of-rotation assessment.
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Affiliation(s)
- A Régent
- Université de Paris, 15, rue de l'école de médecine, 75006 Paris, France; Service de médecine interne, centre de référence maladies auto-immunes et systémiques rares d'ile de France, hôpital Cochin, AP-HP-CUP, 75014 Paris, France.
| | - J-B Arlet
- Université de Paris, 15, rue de l'école de médecine, 75006 Paris, France; Service de médecine interne, centre de référence des syndromes drépanocytaires majeurs, hôpital européen Georges-Pompidou, AP-HP-CUP, 75015 Paris, France
| | - G Cheminet
- Université de Paris, 15, rue de l'école de médecine, 75006 Paris, France; Service de médecine interne, centre de référence des syndromes drépanocytaires majeurs, hôpital européen Georges-Pompidou, AP-HP-CUP, 75015 Paris, France
| | - J Pouchot
- Université de Paris, 15, rue de l'école de médecine, 75006 Paris, France; Service de médecine interne, centre de référence des syndromes drépanocytaires majeurs, hôpital européen Georges-Pompidou, AP-HP-CUP, 75015 Paris, France
| | - L Mouthon
- Université de Paris, 15, rue de l'école de médecine, 75006 Paris, France; Service de médecine interne, centre de référence maladies auto-immunes et systémiques rares d'ile de France, hôpital Cochin, AP-HP-CUP, 75014 Paris, France
| | - C Le Jeunne
- Université de Paris, 15, rue de l'école de médecine, 75006 Paris, France; Service de médecine interne, centre de référence maladies auto-immunes et systémiques rares d'ile de France, hôpital Cochin, AP-HP-CUP, 75014 Paris, France
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Dhakal N, Jayasinghe T, Tahir G. BAME medical student perspective: The influence of candidates' physical attributes on assessors' ratings in clinical practice. MEDICAL TEACHER 2021; 43:1456. [PMID: 33852811 DOI: 10.1080/0142159x.2021.1908528] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
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