Abstract
Undergraduate clinical assessors make expert, multifaceted judgements of consultation skills in concert with medical school OSCE grading rubrics. Assessors are not cognitive machines: their judgements are made in the light of prior experience and social interactions with students. It is important to understand assessors’ working conceptualisations of consultation skills and whether they could be used to develop assessment tools for undergraduate assessment. To identify any working conceptualisations that assessors use while assessing undergraduate medical students’ consultation skills and develop assessment tools based on assessors’ working conceptualisations and natural language for undergraduate consultation skills. In semi-structured interviews, 12 experienced assessors from a UK medical school populated a blank assessment scale with personally meaningful descriptors while describing how they made judgements of students’ consultation skills (at exit standard). A two-step iterative thematic framework analysis was performed drawing on constructionism and interactionism. Five domains were found within working conceptualisations of consultation skills: Application of knowledge; Manner with patients; Getting it done; Safety; and Overall impression. Three mechanisms of judgement about student behaviour were identified: observations, inferences and feelings. Assessment tools drawing on participants’ conceptualisations and natural language were generated, including ‘grade descriptors’ for common conceptualisations in each domain by mechanism of judgement and matched to grading rubrics of Fail, Borderline, Pass, Very good. Utilising working conceptualisations to develop assessment tools is feasible and potentially useful. Work is needed to test impact on assessment quality.
Highlights
Consultation skills such as obtaining a medical history and performing a physical examination are core elements of undergraduate medical education (General Medical Council 2011; Novack et al 1993; Sankarapandian et al 2014; Stillman et al 1997; Townsend et al 2001) but their assessment is challenging (Schuwirth and van der Vleuten 2006)
While assessor judgements are highly context dependent (Gingerich et al 2018; Govaerts et al 2011; Hope and Cameron 2015; Yeates et al 2012, 2015) recent research about assessor judgements in post graduate work based assessment may inform our thinking about undergraduate objective structured clinical examinations (OSCEs) assessment
This research aims to take the first steps in determining whether undergraduate assessors hold such working conceptualisations and if they form clusters which may be useful in assessment tools by:
Summary
Consultation skills such as obtaining a medical history and performing a physical examination are core elements of undergraduate medical education (General Medical Council 2011; Novack et al 1993; Sankarapandian et al 2014; Stillman et al 1997; Townsend et al 2001) but their assessment is challenging (Schuwirth and van der Vleuten 2006). While assessor judgements are highly context dependent (Gingerich et al 2018; Govaerts et al 2011; Hope and Cameron 2015; Yeates et al 2012, 2015) recent research about assessor judgements in post graduate work based assessment may inform our thinking about undergraduate OSCE assessment. In postgraduate assessment, assessments of doctors in training by assessors using scales which reflect the assessors’ own working conceptualisations (construct aligned scales) are more reliable (Crossley et al 2011). That undergraduate OSCE assessments would be more reliable if tools aligned to assessors’ working conceptualisations were used
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