Advances in Health Sciences Education

, Volume 23, Issue 4, pp 721–732 | Cite as

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

  • Timothy J. WoodEmail author
  • Debra Pugh
  • Claire Touchie
  • James Chan
  • Susan Humphrey-Murto


There is an increasing focus on factors that influence the variability of rater-based judgments. First impressions are one such factor. First impressions are judgments about people that are made quickly and are based on little information. Under some circumstances, these judgments can be predictive of subsequent decisions. A concern for both examinees and test administrators is whether the relationship remains stable when the performance of the examinee changes. That is, once a first impression is formed, to what degree will an examiner be willing to modify it? The purpose of this study is to determine the degree that first impressions influence final ratings when the performance of examinees changes within the context of an objective structured clinical examination (OSCE). Physician examiners (n = 29) viewed seven videos of examinees (i.e., actors) performing a physical exam on a single OSCE station. They rated the examinees’ clinical abilities on a six-point global rating scale after 60 s (first impression or FIGR). They then observed the examinee for the remainder of the station and provided a final global rating (GRS). For three of the videos, the examinees’ performance remained consistent throughout the videos. For two videos, examinee performance changed from initially strong to weak and for two videos, performance changed from initially weak to strong. The mean FIGR rating for the Consistent condition (M = 4.80) and the Strong to Weak condition (M = 4.87) were higher compared to their respective GRS ratings (M = 3.93, M = 2.73) with a greater decline for the Strong to Weak condition. The mean FIGR rating for the Weak to Strong condition was lower (3.60) than the corresponding mean GRS (4.81). This pattern of findings suggests that raters were willing to change their judgments based on examinee performance. Future work should explore the impact of making a first impression judgment explicit versus implicit and the role of context on the relationship between a first impression and a subsequent judgment.


Rater cognition First impressions Rater-based assessment 



This research was supported in part by a research grant from the Medical Council of Canada and from the Department of Medicine, University of Ottawa. The authors would like to acknowledge Lesley Ananny, Meredith Mackay, and Katherine Scowcroft for their help on this study as well as the Department of Innovation in Medical Education.


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Copyright information

© Springer Science+Business Media B.V., part of Springer Nature 2018

Authors and Affiliations

  1. 1.Department of Innovation in Medical Education, Faculty of MedicineUniversity of OttawaOttawaCanada
  2. 2.Department of Medicine, Faculty of MedicineUniversity of OttawaOttawaCanada

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