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"Could You Work in My Team?": Exploring How Professional Clinical Role Expectations Influence Decision-Making of
Bunmi S Malau-Aduli1, Richard B Hays1, Karen D'Souza2
1College of Medicine and Dentistry, James Cook University, Townsville, QLD, Australia.
Frontiers in Medicine
|May 23, 2022
Summary
Experienced clinical assessors use a "prototypical intern" mental construct to guide complex decisions in Objective Structured Clinical Examinations (OSCEs). This heuristic aids judgment calibration, especially in challenging situations.
Area of Science:
- Medical Education
- Clinical Assessment
- Qualitative Research
Background:
- Clinical decision-making in medical education assessments, like Objective Structured Clinical Examinations (OSCEs), is intricate.
- Understanding assessor perceptions is crucial for improving assessment validity.
Purpose of the Study:
- To explore how the concept of a "prototypical intern" influences clinical assessors' judgments during OSCEs.
- To apply Cultural Historical Activity Theory (CHAT) to analyze assessment decision-making complexities.
Main Methods:
- Empirical phenomenological qualitative approach with thematic analysis.
- Focus group discussions with 20 experienced and less experienced assessors from ten Australasian medical schools.
- Application of thematic analysis to the Cultural Historical Activity Theory (CHAT) framework.
Main Results:
- Four themes emerged: rubric suitability, student competence vs. prototypical performance, assessing safety/trustworthiness, and contradictions in decision-making.
- More experienced/clinically engaged assessors utilize a "prototypical intern" heuristic for judgment calibration, particularly in difficult cases.
- Themes aligned with CHAT's academic and clinical activity systems.
Conclusions:
- The "prototypical intern" concept significantly influences clinical assessor judgments in OSCEs.
- Further research should investigate consensus on desirable intern qualities to enhance OSCE validity and reduce cognitive load.
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