Feedback Credibility in a Formative Postgraduate Objective Structured Clinical Examination: Effects of Examiner Type.

Abstract

Resident perspectives on feedback are key determinants of its acceptance and effectiveness, and provider credibility is a critical element in perspective formation. It is unclear what factors influence a resident's judgment of feedback credibility. We examined how residents perceive the credibility of feedback providers during a formative objective structured clinical examination (OSCE) in 2 ways: (1) ratings of faculty examiners compared with standardized patient (SP) examiners, and (2) ratings of faculty examiners based on alignment of expertise and station content. During a formative OSCE, internal medicine residents were randomized to receive immediate feedback from either faculty examiners or SP examiners on communication stations, and at least 1 specialty congruent and either 1 specialty incongruent or general internist faculty examiner for clinical stations. Residents rated perceived credibility of feedback providers on a 7-point scale. Results were analyzed with proportional odds models for ordinal credibility ratings. A total of 192 of 203 residents (95%), 72 faculty, and 10 SPs participated. For communication stations, odds of high credibility ratings were significantly lower for SP than for faculty examiners (odds ratio [OR] = 0.28, P < .001). For clinical stations, credibility odds were lower for specialty incongruent faculty (OR = 0.19, P < .001) and female faculty (OR = 0.45, P < .001). Faculty examiners were perceived as being more credible than SP examiners, despite standardizing feedback delivery. Specialty incongruency with station content and female sex were associated with lower credibility ratings for faculty examiners.