Can physician examiners overcome their first impression when examinee performance changes?

Area of Science:

• Medical Education Research
• Psychology of Judgment and Decision-Making
• Performance Assessment

Background:

• Rater-based judgments in assessments are subject to variability.
• First impressions, formed quickly with limited information, can influence subsequent decisions.
• A key concern is whether initial judgments in objective structured clinical examinations (OSCEs) persist despite changes in examinee performance.

Purpose of the Study:

• To determine the extent to which first impressions impact final ratings in OSCEs.
• To investigate if raters modify their judgments when examinee performance changes during an OSCE.

Main Methods:

• Physician examiners (n=29) rated actors' clinical performance in standardized OSCE videos.
• Initial global ratings (FIGR) were recorded after 60 seconds (first impression).
• Final global ratings (GRS) were provided after observing the full performance, with conditions including consistent, strong-to-weak, and weak-to-strong performance changes.

Main Results:

• Mean initial ratings (FIGR) were higher than final ratings (GRS) in consistent and strong-to-weak performance conditions, with a notable decline in the latter.
• In the weak-to-strong performance condition, the mean initial rating (FIGR) was lower than the final rating (GRS).
• These findings indicate that raters were willing to adjust their judgments based on observed performance variations.

Conclusions:

• First impressions can influence initial ratings in OSCEs, but these judgments are modifiable.
• Examiner ratings adapt to demonstrated changes in examinee performance.
• Future research should explore the explicit versus implicit nature of first impressions and contextual factors affecting judgment.