Using Video Technology to Improve Fairness in Objective Structured Clinical Examination Scoring.

Abstract

To the Editor: We read with great interest the article by Yeates and colleagues 1 addressing the impact of examiner variability on the Objective Structured Clinical Examination (OSCE) scores and using novel technology to combat this. As fourth-year medical students from Imperial College London, this article particularly resonated with us, and we encourage changes to improve the fairness of OSCE scoring. We support the implementation of Video-based Examiner Score Comparison and Adjustment (VESCA) because it not only enhances fairness in OSCE scoring but it also has the potential to revolutionize the structure of the OSCE. As the Internet system is further developed, it could eventually negate the need for a live examiner. During our recent OSCE, we felt that examiners with favorable facial expressions and open body language may have reduced stress and helped students perform better than they would have otherwise. Although management of nonverbal cues may be covered in training, we believe that remote Internet scoring would be a more effective solution. Conversely, VESCA does not take into consideration Simulated Patients’ (SPs) behavior and portrayal of the condition. SPs’ physical and verbal portrayal contributes significantly to how candidates interact with them. Tamblyn and colleagues 2 found that SPs who received 2 training sessions depicted the condition more accurately than those who received 1. We have experienced how SPs can affect candidate scores, as they also grade students during the OSCE. Therefore, SPs must be trained regularly and be assessed during the OSCE. SP regulations, in combination with VESCA, could improve the overall fairness of the OSCE. To further the study and encourage future implementation of VESCA, we suggest adopting an alternative approach to participant recruitment. Voluntary participation for VESCA raises the question of whether students who were more confident in their abilities opted to participate. We suggest that an opt-out approach could be adopted to increase participant numbers and result in a more accurate depiction of the original cohort. In fact, it may be of interest to study if borderline students perform better with unobtrusive cameras rather than a live examiner in the room.