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Marangoni S, Steagall PV. Video-based compilation of acute pain behaviours in cats. J Feline Med Surg 2024; 26:1098612X241260712. [PMID: 39286948 PMCID: PMC11418623 DOI: 10.1177/1098612x241260712] [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] [Accepted: 05/22/2024] [Indexed: 09/19/2024]
Abstract
OBJECTIVES The aim of this work was to create a video-based compilation of acute pain behaviours in cats as an open-access online resource for training of veterinary health professionals. METHODS A database comprising 60 h of video recordings of cats was used. Videos were previously recorded after ethical approval and written client consent forms, and involved cats with different types (eg, medical, surgical, trauma, orofacial) and degrees (eg, from no pain to severe pain) of acute pain, before and after surgery or the administration of analgesia. The database included videos of cats of different coat colours, ages, sex and breeds. Video selection was based on a published ethogram of acute pain behaviours in cats. Videos were selected by one observer (SM) according to their definition and quality, followed by a second round of screening by two observers (SM and PVS). Video editing included a standardised template (ie, watermark and titles). RESULTS A total of 24 videos (mean length 33 ± 17 s) with each acute pain-related behaviour described in the ethogram were uploaded to an open-access online video-sharing platform (http://www.youtube.com/@Steagalllaboratory) with an individual hyperlink. Videos were provided with a short description of the behaviour for the public. CONCLUSIONS AND RELEVANCE This video-based compilation may promote better training of veterinary health professionals on acute pain assessment while improving feline health and welfare and the understanding of cat behaviours.
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Affiliation(s)
- Sabrine Marangoni
- Department of Clinical Sciences, Université de Montréal, St-Hyacinthe, QC, Canada
- Department of Veterinary Clinical Sciences, City University of Hong Kong, Hong Kong SAR, China
| | - Paulo V Steagall
- Department of Clinical Sciences, Université de Montréal, St-Hyacinthe, QC, Canada
- Department of Veterinary Clinical Sciences, City University of Hong Kong, Hong Kong SAR, China
- Centre of Animal Health and Welfare, City University of Hong Kong, Hong Kong SAR, China
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Yeates P, Maluf A, McCray G, Kinston R, Cope N, Cullen K, O'Neill V, Cole A, Chung CW, Goodfellow R, Vallender R, Ensaff S, Goddard-Fuller R, McKinley R. Inter-school variations in the standard of examiners' graduation-level OSCE judgements. MEDICAL TEACHER 2024:1-9. [PMID: 38976711 DOI: 10.1080/0142159x.2024.2372087] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/16/2024] [Accepted: 06/20/2024] [Indexed: 07/10/2024]
Abstract
INTRODUCTION Ensuring equivalence in high-stakes performance exams is important for patient safety and candidate fairness. We compared inter-school examiner differences within a shared OSCE and resulting impact on students' pass/fail categorisation. METHODS The same 6 station formative OSCE ran asynchronously in 4 medical schools, with 2 parallel circuits/school. We compared examiners' judgements using Video-based Examiner Score Comparison and Adjustment (VESCA): examiners scored station-specific comparator videos in addition to 'live' student performances, enabling 1/controlled score comparisons by a/examiner-cohorts and b/schools and 2/data linkage to adjust for the influence of examiner-cohorts. We calculated score impact and change in pass/fail categorisation by school. RESULTS On controlled video-based comparisons, inter-school variations in examiners' scoring (16.3%) were nearly double within-school variations (8.8%). Students' scores received a median adjustment of 5.26% (IQR 2.87-7.17%). The impact of adjusting for examiner differences on students' pass/fail categorisation varied by school, with adjustment reducing failure rate from 39.13% to 8.70% (school 2) whilst increasing failure from 0.00% to 21.74% (school 4). DISCUSSION Whilst the formative context may partly account for differences, these findings query whether variations may exist between medical schools in examiners' judgements. This may benefit from systematic appraisal to safeguard equivalence. VESCA provided a viable method for comparisons.
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Affiliation(s)
- Peter Yeates
- School of Medicine, Keele University, Keele, United Kingdom
| | | | - Gareth McCray
- School of Medicine, Keele University, Keele, United Kingdom
| | - Ruth Kinston
- School of Medicine, Keele University, Keele, United Kingdom
| | - Natalie Cope
- School of Medicine, Keele University, Keele, United Kingdom
| | - Kathy Cullen
- School of Medicine, Dentistry and Biomedical Sciences, Queens University Belfast, Belfast, United Kingdom
| | - Vikki O'Neill
- School of Medicine, Dentistry and Biomedical Sciences, Queens University Belfast, Belfast, United Kingdom
| | - Aidan Cole
- School of Medicine, Dentistry and Biomedical Sciences, Queens University Belfast, Belfast, United Kingdom
| | - Ching-Wa Chung
- School of Medicine, Medical Sciences and Nutrition, University of Aberdeen, Aberdeen, United Kingdom
| | | | | | - Sue Ensaff
- School of Medicine, Cardiff University, Cardiff, United Kingdom
| | - Rikki Goddard-Fuller
- Christie Education, Christie Hospitals NHS Foundation Trust, Manchester, United Kingdom
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Homer M. Towards a more nuanced conceptualisation of differential examiner stringency in OSCEs. ADVANCES IN HEALTH SCIENCES EDUCATION : THEORY AND PRACTICE 2024; 29:919-934. [PMID: 37843678 PMCID: PMC11208245 DOI: 10.1007/s10459-023-10289-w] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/28/2023] [Accepted: 09/24/2023] [Indexed: 10/17/2023]
Abstract
Quantitative measures of systematic differences in OSCE scoring across examiners (often termed examiner stringency) can threaten the validity of examination outcomes. Such effects are usually conceptualised and operationalised based solely on checklist/domain scores in a station, and global grades are not often used in this type of analysis. In this work, a large candidate-level exam dataset is analysed to develop a more sophisticated understanding of examiner stringency. Station scores are modelled based on global grades-with each candidate, station and examiner allowed to vary in their ability/stringency/difficulty in the modelling. In addition, examiners are also allowed to vary in how they discriminate across grades-to our knowledge, this is the first time this has been investigated. Results show that examiners contribute strongly to variance in scoring in two distinct ways-via the traditional conception of score stringency (34% of score variance), but also in how they discriminate in scoring across grades (7%). As one might expect, candidate and station account only for a small amount of score variance at the station-level once candidate grades are accounted for (3% and 2% respectively) with the remainder being residual (54%). Investigation of impacts on station-level candidate pass/fail decisions suggest that examiner differential stringency effects combine to give false positive (candidates passing in error) and false negative (failing in error) rates in stations of around 5% each but at the exam-level this reduces to 0.4% and 3.3% respectively. This work adds to our understanding of examiner behaviour by demonstrating that examiners can vary in qualitatively different ways in their judgments. For institutions, it emphasises the key message that it is important to sample widely from the examiner pool via sufficient stations to ensure OSCE-level decisions are sufficiently defensible. It also suggests that examiner training should include discussion of global grading, and the combined effect of scoring and grading on candidate outcomes.
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Affiliation(s)
- Matt Homer
- School of Medicine, University of Leeds, Leeds, LS2 JT, UK.
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4
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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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Yeates P, Maluf A, Cope N, McCray G, McBain S, Beardow D, Fuller R, McKinley RB. Using video-based examiner score comparison and adjustment (VESCA) to compare the influence of examiners at different sites in a distributed objective structured clinical exam (OSCE). BMC MEDICAL EDUCATION 2023; 23:803. [PMID: 37885005 PMCID: PMC10605484 DOI: 10.1186/s12909-023-04774-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/09/2023] [Accepted: 10/14/2023] [Indexed: 10/28/2023]
Abstract
PURPOSE Ensuring equivalence of examiners' judgements within distributed objective structured clinical exams (OSCEs) is key to both fairness and validity but is hampered by lack of cross-over in the performances which different groups of examiners observe. This study develops a novel method called Video-based Examiner Score Comparison and Adjustment (VESCA) using it to compare examiners scoring from different OSCE sites for the first time. MATERIALS/ METHODS Within a summative 16 station OSCE, volunteer students were videoed on each station and all examiners invited to score station-specific comparator videos in addition to usual student scoring. Linkage provided through the video-scores enabled use of Many Facet Rasch Modelling (MFRM) to compare 1/ examiner-cohort and 2/ site effects on students' scores. RESULTS Examiner-cohorts varied by 6.9% in the overall score allocated to students of the same ability. Whilst only a tiny difference was apparent between sites, examiner-cohort variability was greater in one site than the other. Adjusting student scores produced a median change in rank position of 6 places (0.48 deciles), however 26.9% of students changed their rank position by at least 1 decile. By contrast, only 1 student's pass/fail classification was altered by score adjustment. CONCLUSIONS Whilst comparatively limited examiner participation rates may limit interpretation of score adjustment in this instance, this study demonstrates the feasibility of using VESCA for quality assurance purposes in large scale distributed OSCEs.
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Affiliation(s)
- Peter Yeates
- School of Medicine, Keele University, David Weatherall Building, Keele, Staffordshire, ST5 5BG, UK.
- Fairfield General Hospital, Northern Care Alliance NHS Foundation Trust, Bury, Greater Manchester, UK.
| | - Adriano Maluf
- School of Medicine, Keele University, David Weatherall Building, Keele, Staffordshire, ST5 5BG, UK
| | - Natalie Cope
- School of Medicine, Keele University, David Weatherall Building, Keele, Staffordshire, ST5 5BG, UK
| | - Gareth McCray
- School of Medicine, Keele University, David Weatherall Building, Keele, Staffordshire, ST5 5BG, UK
| | - Stuart McBain
- School of Medicine, Keele University, David Weatherall Building, Keele, Staffordshire, ST5 5BG, UK
| | - Dominic Beardow
- School of Medicine, Keele University, David Weatherall Building, Keele, Staffordshire, ST5 5BG, UK
| | - Richard Fuller
- Christie Education, Christie Hospitals NHS Foundation Trust, Manchester , UK
| | - Robert Bob McKinley
- School of Medicine, Keele University, David Weatherall Building, Keele, Staffordshire, ST5 5BG, UK
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Yeates P, Maluf A, Kinston R, Cope N, McCray G, Cullen K, O'Neill V, Cole A, Goodfellow R, Vallender R, Chung CW, McKinley RK, Fuller R, Wong G. Enhancing authenticity, diagnosticity and equivalence (AD-Equiv) in multicentre OSCE exams in health professionals education: protocol for a complex intervention study. BMJ Open 2022; 12:e064387. [PMID: 36600366 PMCID: PMC9730346 DOI: 10.1136/bmjopen-2022-064387] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/04/2022] [Accepted: 10/12/2022] [Indexed: 12/12/2022] Open
Abstract
INTRODUCTION Objective structured clinical exams (OSCEs) are a cornerstone of assessing the competence of trainee healthcare professionals, but have been criticised for (1) lacking authenticity, (2) variability in examiners' judgements which can challenge assessment equivalence and (3) for limited diagnosticity of trainees' focal strengths and weaknesses. In response, this study aims to investigate whether (1) sharing integrated-task OSCE stations across institutions can increase perceived authenticity, while (2) enhancing assessment equivalence by enabling comparison of the standard of examiners' judgements between institutions using a novel methodology (video-based score comparison and adjustment (VESCA)) and (3) exploring the potential to develop more diagnostic signals from data on students' performances. METHODS AND ANALYSIS The study will use a complex intervention design, developing, implementing and sharing an integrated-task (research) OSCE across four UK medical schools. It will use VESCA to compare examiner scoring differences between groups of examiners and different sites, while studying how, why and for whom the shared OSCE and VESCA operate across participating schools. Quantitative analysis will use Many Facet Rasch Modelling to compare the influence of different examiners groups and sites on students' scores, while the operation of the two interventions (shared integrated task OSCEs; VESCA) will be studied through the theory-driven method of Realist evaluation. Further exploratory analyses will examine diagnostic performance signals within data. ETHICS AND DISSEMINATION The study will be extra to usual course requirements and all participation will be voluntary. We will uphold principles of informed consent, the right to withdraw, confidentiality with pseudonymity and strict data security. The study has received ethical approval from Keele University Research Ethics Committee. Findings will be academically published and will contribute to good practice guidance on (1) the use of VESCA and (2) sharing and use of integrated-task OSCE stations.
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Affiliation(s)
- Peter Yeates
- School of Medicine, Keele University, Keele, Staffordshire, UK
| | - Adriano Maluf
- School of Medicine, Keele University, Keele, Staffordshire, UK
| | - Ruth Kinston
- School of Medicine, Keele University, Keele, Staffordshire, UK
| | - Natalie Cope
- School of Medicine, Keele University, Keele, Staffordshire, UK
| | - Gareth McCray
- School of Medicine, Keele University, Keele, Staffordshire, UK
| | - Kathy Cullen
- School of Medicine, Dentistry and Biomedical Sciences, Queen's University Belfast, Belfast, UK
| | - Vikki O'Neill
- School of Medicine, Dentistry and Biomedical Sciences, Queen's University Belfast, Belfast, UK
| | - Aidan Cole
- School of Medicine, Dentistry and Biomedical Sciences, Queen's University Belfast, Belfast, UK
| | | | | | - Ching-Wa Chung
- School of Medicine, Medical Sciences and Nutrition, University of Aberdeen, Aberdeen, Scotland, UK
| | | | - Richard Fuller
- School of Medicine, University of Liverpool Faculty of Health and Life Sciences, Liverpool, UK
| | - Geoff Wong
- Nuffield Department of Primary Care Health Sciences, University of Oxford Division of Public Health and Primary Health Care, Oxford, Oxfordshire, UK
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Fuller R, Goddard VCT, Nadarajah VD, Treasure-Jones T, Yeates P, Scott K, Webb A, Valter K, Pyorala E. Technology enhanced assessment: Ottawa consensus statement and recommendations. MEDICAL TEACHER 2022; 44:836-850. [PMID: 35771684 DOI: 10.1080/0142159x.2022.2083489] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
INTRODUCTION In 2011, a consensus report was produced on technology-enhanced assessment (TEA), its good practices, and future perspectives. Since then, technological advances have enabled innovative practices and tools that have revolutionised how learners are assessed. In this updated consensus, we bring together the potential of technology and the ultimate goals of assessment on learner attainment, faculty development, and improved healthcare practices. METHODS As a material for the report, we used the scholarly publications on TEA in both HPE and general higher education, feedback from 2020 Ottawa Conference workshops, and scholarly publications on assessment technology practices during the Covid-19 pandemic. RESULTS AND CONCLUSION The group identified areas of consensus that remained to be resolved and issues that arose in the evolution of TEA. We adopted a three-stage approach (readiness to adopt technology, application of assessment technology, and evaluation/dissemination). The application stage adopted an assessment 'lifecycle' approach and targeted five key foci: (1) Advancing authenticity of assessment, (2) Engaging learners with assessment, (3) Enhancing design and scheduling, (4) Optimising assessment delivery and recording learner achievement, and (5) Tracking learner progress and faculty activity and thereby supporting longitudinal learning and continuous assessment.
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Affiliation(s)
- Richard Fuller
- Christie Education, The Christie NHS Foundation Trust, Manchester, UK
| | | | | | | | - Peter Yeates
- School of Medicine, University of Keele, Keele, UK
| | - Karen Scott
- Faculty of Medicine and Health, University of Sydney, Sydney, Australia
| | - Alexandra Webb
- College of Health and Medicine, Australian National University, Canberra, Australia
| | - Krisztina Valter
- John Curtin School of Medical Research, Australian National University, Canberra, Australia
| | - Eeva Pyorala
- Center for University Teaching and Learning, University of Helsinki, Helsinki, Finland
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Makrides A, Yeates P. Memory, credibility and insight: How video-based feedback promotes deeper reflection and learning in objective structured clinical exams. MEDICAL TEACHER 2022; 44:664-671. [PMID: 35000530 DOI: 10.1080/0142159x.2021.2020232] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
INTRODUCTION Providing high-quality feedback from Objective Structured Clinical Exams (OSCEs) is important but challenging. Whilst prior research suggests that video-based feedback (VbF), where students review their own performances alongside usual examiner feedback, may usefully enhance verbal or written feedback, little is known about how students experience or interact with VbF or what mechanisms may underly any such benefits. METHODS We used social constructive grounded theory to explore students' interaction with VbF. Within semi-structured interviews, students reviewed their verbal feedback from examiners before watching a video of the same performance, reflecting with the interviewer before and after the video. Transcribed interviews were analysed using grounded theory analysis methods. RESULT Videos greatly enhanced students' memories of their performance, which increased their receptivity to and the credibility of examiners' feedback. Reflecting on video performances produced novel insights for students beyond the points described by examiners. Students triangulated these novel insights with their own self-assessment and experiences from practice to reflect deeply on their performance which led to the generation of additional, often patient-orientated, learning objectives. CONCLUSIONS The array of beneficial mechanisms evoked by VbF suggests it may be a powerful means to richly support students' learning in both formative and summative contexts.
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Affiliation(s)
- Alexandra Makrides
- School of Medicine, Keele University, Keele, Staffordshire, United Kingdom
| | - Peter Yeates
- School of Medicine, Keele University, Keele, Staffordshire, United Kingdom
- Fairfield General Hospital, Pennine Acute Hospitals NHS Trust, Bury, Lancashire, United Kingdom
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Yeates P, Fuller R, McKinley RKB. In Reply to Anto et al. ACADEMIC MEDICINE : JOURNAL OF THE ASSOCIATION OF AMERICAN MEDICAL COLLEGES 2022; 97:475-476. [PMID: 35353728 DOI: 10.1097/acm.0000000000004582] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Affiliation(s)
- Peter Yeates
- Senior lecturer in medical education research, School of Medicine, Keele University, Keele, Staffordshire, and a consultant in acute and respiratory medicine, Fairfield General Hospital, Pennine Acute Hospitals, NHS Trust, Bury, Lancashire, United Kingdom; ; ORCID: https://orcid.org/0000-0001-6316-4051
| | - Richard Fuller
- Director of Christie Education, Christie Hospitals NHS Trust/University of Manchester, Manchester, United Kingdom; ORCID: https://orcid.org/0000-0001-7965-4864
| | - Robert K Bob McKinley
- Emeritus professor of education in general practice, School of Medicine, Keele University, Keele, Staffordshire, United Kingdom; ORCID: https://orcid.org/0000-0002-3684-3435
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Macauley K, Laprino S, Brudvig T. Perceptions of Physical Therapy Students on their Psychomotor Examinations: a Qualitative Study. MEDICAL SCIENCE EDUCATOR 2022; 32:349-360. [PMID: 35528290 PMCID: PMC9054959 DOI: 10.1007/s40670-022-01514-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 01/21/2022] [Indexed: 06/14/2023]
Abstract
INTRODUCTION Practical examinations are necessary to demonstrate learning in the psychomotor, cognitive, and affective domains. Student perceptions of the organization and execution of practical examinations are an important consideration in the development of practical examinations. REVIEW OF THE LITERATURE Multiple other health professions have investigated students' perceptions of objective structured clinical examinations (OSCE). There is little in the physical therapy literature with respect to student perception regarding proctor presence during practical examinations or OSCEs. SUBJECTS The participants were members of the classes of 2019-2021 in a Doctor of Physical Therapy (DPT) program at a New England University. METHODS A qualitative thematic approach was applied to de-identified transcripts of student focus group interviews. Independently coded themes were identified, discussed, and refined iteratively. RESULTS AND DISCUSSION Four themes emerged with multiple subthemes: impact of proctor being present; realistic, patient-focused experience; preparation for the practical; and stress. Students valued preparation that included clear expectations, utilization of formative assessments, and peer feedback prior to the practical. They also noted that a distractive-free testing space, having no proctor present in the room, recording the practical, and the format of OSCE's decreased stress and improved performance. CONCLUSIONS These findings add to the body of knowledge in physical therapy and provide guidance to faculty as they plan and organize practical examinations.
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Yeates P, Moult A, Cope N, McCray G, Fuller R, McKinley R. Determining influence, interaction and causality of contrast and sequence effects in objective structured clinical exams. MEDICAL EDUCATION 2022; 56:292-302. [PMID: 34893998 PMCID: PMC9304241 DOI: 10.1111/medu.14713] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 07/23/2021] [Revised: 11/03/2021] [Accepted: 12/08/2021] [Indexed: 06/14/2023]
Abstract
INTRODUCTION Differential rater function over time (DRIFT) and contrast effects (examiners' scores biased away from the standard of preceding performances) both challenge the fairness of scoring in objective structured clinical exams (OSCEs). This is important as, under some circumstances, these effects could alter whether some candidates pass or fail assessments. Benefitting from experimental control, this study investigated the causality, operation and interaction of both effects simultaneously for the first time in an OSCE setting. METHODS We used secondary analysis of data from an OSCE in which examiners scored embedded videos of student performances interspersed between live students. Embedded video position varied between examiners (early vs. late) whilst the standard of preceding performances naturally varied (previous high or low). We examined linear relationships suggestive of DRIFT and contrast effects in all within-OSCE data before comparing the influence and interaction of 'early' versus 'late' and 'previous high' versus 'previous low' conditions on embedded video scores. RESULTS Linear relationships data did not support the presence of DRIFT or contrast effects. Embedded videos were scored higher early (19.9 [19.4-20.5]) versus late (18.6 [18.1-19.1], p < 0.001), but scores did not differ between previous high and previous low conditions. The interaction term was non-significant. CONCLUSIONS In this instance, the small DRIFT effect we observed on embedded videos can be causally attributed to examiner behaviour. Contrast effects appear less ubiquitous than some prior research suggests. Possible mediators of these finding include the following: OSCE context, detail of task specification, examiners' cognitive load and the distribution of learners' ability. As the operation of these effects appears to vary across contexts, further research is needed to determine the prevalence and mechanisms of contrast and DRIFT effects, so that assessments may be designed in ways that are likely to avoid their occurrence. Quality assurance should monitor for these contextually variable effects in order to ensure OSCE equivalence.
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Affiliation(s)
- Peter Yeates
- School of MedicineKeele UniversityKeeleUK
- Fairfield General HospitalPennine Acute Hospitals NHS TrustBuryUK
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12
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Yeates P, McCray G, Moult A, Cope N, Fuller R, McKinley R. Determining the influence of different linking patterns on the stability of students' score adjustments produced using Video-based Examiner Score Comparison and Adjustment (VESCA). BMC MEDICAL EDUCATION 2022; 22:41. [PMID: 35039023 PMCID: PMC8764767 DOI: 10.1186/s12909-022-03115-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 01/22/2021] [Accepted: 01/05/2022] [Indexed: 06/14/2023]
Abstract
BACKGROUND Ensuring equivalence of examiners' judgements across different groups of examiners is a priority for large scale performance assessments in clinical education, both to enhance fairness and reassure the public. This study extends insight into an innovation called Video-based Examiner Score Comparison and Adjustment (VESCA) which uses video scoring to link otherwise unlinked groups of examiners. This linkage enables comparison of the influence of different examiner-groups within a common frame of reference and provision of adjusted "fair" scores to students. Whilst this innovation promises substantial benefit to quality assurance of distributed Objective Structured Clinical Exams (OSCEs), questions remain about how the resulting score adjustments might be influenced by the specific parameters used to operationalise VESCA. Research questions, How similar are estimates of students' score adjustments when the model is run with either: fewer comparison videos per participating examiner?; reduced numbers of participating examiners? METHODS Using secondary analysis of recent research which used VESCA to compare scoring tendencies of different examiner groups, we made numerous copies of the original data then selectively deleted video scores to reduce the number of 1/ linking videos per examiner (4 versus several permutations of 3,2,or 1 videos) or 2/examiner participation rates (all participating examiners (76%) versus several permutations of 70%, 60% or 50% participation). After analysing all resulting datasets with Many Facet Rasch Modelling (MFRM) we calculated students' score adjustments for each dataset and compared these with score adjustments in the original data using Spearman's correlations. RESULTS Students' score adjustments derived form 3 videos per examiner correlated highly with score adjustments derived from 4 linking videos (median Rho = 0.93,IQR0.90-0.95,p < 0.001), with 2 (median Rho 0.85,IQR0.81-0.87,p < 0.001) and 1 linking videos (median Rho = 0.52(IQR0.46-0.64,p < 0.001) producing progressively smaller correlations. Score adjustments were similar for 76% participating examiners and 70% (median Rho = 0.97,IQR0.95-0.98,p < 0.001), and 60% (median Rho = 0.95,IQR0.94-0.98,p < 0.001) participation, but were lower and more variable for 50% examiner participation (median Rho = 0.78,IQR0.65-0.83, some ns). CONCLUSIONS Whilst VESCA showed some sensitivity to the examined parameters, modest reductions in examiner participation rates or video numbers produced highly similar results. Employing VESCA in distributed or national exams could enhance quality assurance or exam fairness.
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Affiliation(s)
- Peter Yeates
- School of Medicine, David Weatherall Building, Keele University, Keele, Staffordshire, ST5 5BG, UK.
- Fairfield General Hospital, Northern Care Alliance NHS Foundation Trust, Rochdale Old Road, Bury, BL9 7TD, Lancashire, UK.
| | - Gareth McCray
- School of Medicine, David Weatherall Building, Keele University, Keele, Staffordshire, ST5 5BG, UK
| | - Alice Moult
- School of Medicine, David Weatherall Building, Keele University, Keele, Staffordshire, ST5 5BG, UK
| | - Natalie Cope
- School of Medicine, David Weatherall Building, Keele University, Keele, Staffordshire, ST5 5BG, UK
| | - Richard Fuller
- Christie Education, Christie Hospitals NHS Foundation Trust, Wilmslow Rd, Manchester, M20 4BX, UK
| | - Robert McKinley
- School of Medicine, David Weatherall Building, Keele University, Keele, Staffordshire, ST5 5BG, UK
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Moult A, McKinley RK, Yeates P. Understanding patient involvement in judging students' communication skills in OSCEs. MEDICAL TEACHER 2021; 43:1070-1078. [PMID: 34496725 DOI: 10.1080/0142159x.2021.1915467] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/13/2023]
Abstract
INTRODUCTION Communication skills are assessed by medically-enculturated examiners using consensus frameworks which were developed with limited patient involvement. Assessments consequently risk rewarding performance which incompletely serves patients' authentic communication needs. Whilst regulators require patient involvement in assessment, little is known about how this can be achieved. We aimed to explore patients' perceptions of students' communication skills, examiner feedback and potential roles for patients in assessment. METHODS Using constructivist grounded theory we performed cognitive stimulated, semi-structured interviews with patients who watched videos of student performances in communication-focused OSCE stations and read corresponding examiner feedback. Data were analysed using grounded theory methods. RESULTS A disconnect occurred between participants' and examiners' views of students' communication skills. Whilst patients frequently commented on students' use of medical terminology, examiners omitted to mention this in feedback. Patients' judgements of students' performances varied widely, reflecting different preferences and beliefs. Participants viewed variability as an opportunity for students to learn from diverse lived experiences. Participants perceived a variety of roles to enhance assessment authenticity. DISCUSSION Integrating patients into communications skills assessments could help to highlight deficiencies in students' communication which medically-enculturated examiners may miss. Overcoming the challenges inherent to this is likely to enhance graduates' preparedness for practice.
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Affiliation(s)
- Alice Moult
- School of Medicine, Keele University, Keele, UK
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