Abstract
BackgroundThe International Membership Examination (MRCGP[INT]) of the Royal College of General Practitioners UK is a unique collaboration between four South Asian countries with diverse cultures, epidemiology, clinical facilities and resources. In this setting good quality assurance is imperative to achieve acceptable standards of inter rater reliability. This study aims to explore the process of peer feedback for examiner quality assurance with regard to factors affecting the implementation and acceptance of the method.MethodsA sequential mixed methods approach was used based on focus group discussions with examiners (n = 12) and clinical examination convenors who acted as peer reviewers (n = 4). A questionnaire based on emerging themes and literature review was then completed by 20 examiners at the subsequent OSCE exam. Qualitative data were analysed using an iterative reflexive process. Quantitative data were integrated by interpretive analysis looking for convergence, complementarity or dissonance. The qualitative data helped understand the issues and informed the process of developing the questionnaire. The quantitative data allowed for further refining of issues, wider sampling of examiners and giving voice to different perspectives.ResultsExaminers stated specifically that peer feedback gave an opportunity for discussion, standardisation of judgments and improved discriminatory abilities. Interpersonal dynamics, hierarchy and perception of validity of feedback were major factors influencing acceptance of feedback. Examiners desired increased transparency, accountability and the opportunity for equal partnership within the process. The process was stressful for examiners and reviewers; however acceptance increased with increasing exposure to receiving feedback. The process could be refined to improve acceptability through scrupulous attention to training and selection of those giving feedback to improve the perceived validity of feedback and improved reviewer feedback skills to enable better interpersonal dynamics and a more equitable feedback process. It is important to highlight the role of quality assurance and peer feedback as a tool for continuous improvement and maintenance of standards to examiners during training.ConclusionExaminer quality assurance using peer feedback was generally a successful and accepted process. The findings highlight areas for improvement and guide the path towards a model of feedback that is responsive to examiner views and cultural sensibilities.
Highlights
The International Membership Examination (MRCGP[INT]) of the Royal College of General Practitioners United Kingdom (UK) is a unique collaboration between four South Asian countries with diverse cultures, epidemiology, clinical facilities and resources
Two focus group discussions attended by six examiners (FGDE) each were conducted with eight male and four female examiners out of the 23 examiners present throughout the duration of the exam (Sri Lanka 2, Pakistan 19, Bangladesh 1, United Kingdom 1) by the principal investigator (DP) (Table 1)
Qualitative findings The utility of peer feedback There was general consensus among examiners that peer feedback was an important aspect of quality assurance
Summary
The International Membership Examination (MRCGP[INT]) of the Royal College of General Practitioners UK is a unique collaboration between four South Asian countries with diverse cultures, epidemiology, clinical facilities and resources. In this setting good quality assurance is imperative to achieve acceptable standards of inter rater reliability. Expertise of family physicians from all member countries is pooled in the design of the assessment process This ensures that the exam is appropriate for family doctors from all member countries as differences in culture, epidemiology, clinical facilities and resources are considered. MRCGP [INT] SA was originally accredited in 2007 and re-accredited in 2010 and 2013
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