PURPOSE: The objective structured clinical examination (OSCE) is considered to be one of the most robust methods of clinical assessment. One of its strengths lies in its ability to minimise the effects of examiner bias due to the standardisation of items and tasks for each candidate. However, OSCE examiners' assessment scores are influenced by several factors that may jeopardise the assumed objectivity of OSCEs. To better understand this phenomenon, the current review aims to determine and describe important sources of examiner bias and the factors affecting examiners' assessments. METHODS: We performed a narrative review of the medical literature using Medline. All articles meeting the selection criteria were reviewed, with salient points extracted and synthesised into a clear and comprehensive summary of the knowledge in this area. RESULTS: OSCE examiners' assessment scores are influenced by factors belonging to 4 different domains: examination context, examinee characteristics, examinee-examiner interactions, and examiner characteristics. These domains are composed of several factors including halo, hawk/dove and OSCE contrast effects; the examiner's gender and ethnicity; training; lifetime experience in assessing; leadership and familiarity with students; station type; and site effects. CONCLUSION: Several factors may influence the presumed objectivity of examiners' assessments, and these factors need to be addressed to ensure the objectivity of OSCEs. We offer insights into directions for future research to better understand and address the phenomenon of examiner bias.
Bias (Epidemiology) ; Humans ; Leadership ; Patient Selection ; Problem Solving ; Recognition (Psychology)

PURPOSE: The biases that may influence objective structured clinical examination (OSCE) scoring are well understood, and recent research has attempted to establish the magnitude of their impact. However, the influence of examiner experience, clinical seniority, and occupation on communication and physical examination scores in OSCEs has not yet been clearly established. METHODS: We compared the mean scores awarded for generic and clinical communication and physical examination skills in 2 undergraduate medicine OSCEs in relation to examiner characteristics (gender, examining experience, occupation, seniority, and speciality). The statistical significance of the differences was calculated using the 2-tailed independent t-test and analysis of variance. RESULTS: Five hundred and seventeen students were examined by 237 examiners at the University of New South Wales in 2014 and 2016. Examiner gender, occupation (academic, clinician, or clinical tutor), and job type (specialist or generalist) did not significantly impact scores. Junior doctors gave consistently higher scores than senior doctors in all domains, and this difference was statistically significant for generic and clinical communication scores. Examiner experience was significantly inversely correlated with generic communication scores. CONCLUSION We suggest that the assessment of examination skills may be less susceptible to bias because this process is fairly prescriptive, affording greater scoring objectivity. We recommend training to define the marking criteria, teaching curriculum, and expected level of performance in communication skills to reduce bias in OSCE assessment.

PURPOSE: The biases that may influence objective structured clinical examination (OSCE) scoring are well understood, and recent research has attempted to establish the magnitude of their impact. However, the influence of examiner experience, clinical seniority, and occupation on communication and physical examination scores in OSCEs has not yet been clearly established. METHODS: We compared the mean scores awarded for generic and clinical communication and physical examination skills in 2 undergraduate medicine OSCEs in relation to examiner characteristics (gender, examining experience, occupation, seniority, and speciality). The statistical significance of the differences was calculated using the 2-tailed independent t-test and analysis of variance. RESULTS: Five hundred and seventeen students were examined by 237 examiners at the University of New South Wales in 2014 and 2016. Examiner gender, occupation (academic, clinician, or clinical tutor), and job type (specialist or generalist) did not significantly impact scores. Junior doctors gave consistently higher scores than senior doctors in all domains, and this difference was statistically significant for generic and clinical communication scores. Examiner experience was significantly inversely correlated with generic communication scores. CONCLUSION: We suggest that the assessment of examination skills may be less susceptible to bias because this process is fairly prescriptive, affording greater scoring objectivity. We recommend training to define the marking criteria, teaching curriculum, and expected level of performance in communication skills to reduce bias in OSCE assessment.
Australia ; Awards and Prizes ; Bias (Epidemiology) ; Curriculum ; Humans ; New South Wales ; Occupations ; Physical Examination

Most medical complications following acute stroke are preventable (such as cardiac events, pneumonia, bed sores and venous thrombosis). This was a study on the frequency of medical complications and their association with key performance indicators. Methods: The study used a cross-sectional baseline audit of stroke care practices. The audit captured details on the nature of the stroke, patient demographics, characteristics of hospital care, and compliance with six key quality indicators in Philippine Academy of Rehabilitation Medicine Clinical Practice Guideline on Stroke Rehabilitation. Patient records were retrospectively consecutively sampled. Results: A total of 1,683 patients were included in the audit which came from 49 hospitals. Medical complications were seen in 182 patients (11.2%). Pneumonia contributed to half the medical complications (50%), followed by respiratory failure (7.7%) and gastrointestinal bleeding (3.8%). Presence of medical complications were associated with in-patient mortality (OR 3.3 (95% CI 2.1-5.3)) and prolonged hospital stay (16.1 ± 20.7 days vs 9.6 + 10.9 days). The best predictor model for pneumonia included variables of not having a swallow screen within the first 24 hours, having a nasogastric tube inserted, not achieving medical stability, not having a stroke unit in the admitting hospital, having suffered a previous stroke and being older. Conclusion: Non-adherence to evidence-based stroke care rehabilitation guidelines contributed significantly to medical complications in an audit of Filipino stroke patients