'We're getting there': Registrar and examiner perspectives on structured oral examinations in emergency medicine

Structured oral examinations (SOEs) are essential for assessing clinical competence in postgraduate emergency medicine qualifications. The rapid shift to web-based SOEs during the coronavirus disease 2019 pandemic and their continued use warrants an exploration of their effectiveness to identify areas for improvement in high-stakes assessments.

A qualitative, exploratory approach situated within an interpretivist paradigm was used to explore the perspectives of registrars and examiners who had participated in a recent web-based Fellowship of the College of Emergency Medicine Part II examination in South Africa. Six registrars and seven examiners participated in semi-structured interviews. Reflexive thematic analysis, guided by Braun and Clarke's approach, was used to identify key themes from the data.

Participants recognised the value of SOEs in assessment but also highlighted areas for improvement. Concerns included misalignment between exam content and clinical reasoning, anxiety because of the high-stakes nature of the assessment and familiarity with examiners and challenges faced by non-native English speakers. Examiners recommended targeted training in question design and bias mitigation.

Enhancing SOEs through better examiner training and bias mitigation will strengthen their effectiveness. Integrating workplace-based assessment (WBAs) will reduce reliance on SOEs, promoting a more comprehensive approach to assessment in emergency medicine.

This study offers practical recommendations for improving examiner training, design and fairness in SOEs. Integrating WBAs with SOEs supports continuous, real-world assessment of competence. Bias-awareness training enhances equity, enabling institutions to design fairer, inclusive assessments.