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Area of Science:

  • Medical Education
  • Clinical Assessment
  • Statistical Modeling

Background:

  • Objective Structured Clinical Examinations (OSCEs) are widely used for medical student evaluation.
  • Standardization challenges arise due to face-to-face interactions in OSCEs.
  • Quantifying and adjusting for examiner effects is crucial for OSCE reliability.

Purpose of the Study:

  • To analyze staff-related and student variability in OSCE scores.
  • To evaluate the impact of consensus grading on score standardization.
  • To propose a statistical method for adjusting inter-rater variability in OSCEs.

Main Methods:

  • Analysis of 16,910 station scores from 2615 student sessions across three OSCEs.
  • Utilized mixed-effects models to assess score variance attributed to staff and students.
  • Compared single-rater versus dual-rater (consensus) scoring sessions.

Main Results:

  • Significant staff-related heterogeneity in OSCE scores (p<10^-15), explaining up to 11.6% of variance.
  • Consensus grading (dual raters) appeared to moderate staff-related heterogeneity.
  • Student variability explained a smaller proportion of variance (8.8%-11.3%), with no improved longitudinal consistency in rankings.

Conclusions:

  • Staff variability in OSCEs is comparable to student variability.
  • Dual assessment and statistical adjustments using mixed models can reduce examiner effects.
  • Unmeasured sources of variability present challenges in consistently capturing OSCE score fluctuations.