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Seeing the same thing differently

Mechanisms that contribute to assessor differences in directly-observed performance assessments

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Abstract

Assessors’ scores in performance assessments are known to be highly variable. Attempted improvements through training or rating format have achieved minimal gains. The mechanisms that contribute to variability in assessors’ scoring remain unclear. This study investigated these mechanisms. We used a qualitative approach to study assessors’ judgements whilst they observed common simulated videoed performances of junior doctors obtaining clinical histories. Assessors commented concurrently and retrospectively on performances, provided scores and follow-up interviews. Data were analysed using principles of grounded theory. We developed three themes that help to explain how variability arises: Differential Salience—assessors paid attention to (or valued) different aspects of the performances to different degrees; Criterion Uncertainty—assessors’ criteria were differently constructed, uncertain, and were influenced by recent exemplars; Information Integration—assessors described the valence of their comments in their own unique narrative terms, usually forming global impressions. Our results (whilst not precluding the operation of established biases) describe mechanisms by which assessors’ judgements become meaningfully-different or unique. Our results have theoretical relevance to understanding the formative educational messages that performance assessments provide. They give insight relevant to assessor training, assessors’ ability to be observationally “objective” and to the educational value of narrative comments (in contrast to numerical ratings).

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Acknowledgments

Thanks to the foundation doctors and simulated patients who were featured in the study videos, to the physicians who helped in validation of the videos, to University Hospital of South Manchester NHS Foundation Trust for acting as the project’s sponsor, to the North Western Deanery for their endorsement and support and to all the research participants. Thanks also to the paper’s reviewers for their very helpful comments on the manuscript. No external funding was received for the study.

Conflicts of interest

None declared.

Ethical approval

Obtained from Manchester West Regional Ethics Committee, ref 09/H1014/72.

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Authors and Affiliations

  1. School of Translational Medicine, University of Manchester, Manchester, UK

    Peter Yeates

  2. The Academy at UHSM, 1st floor, ERC, University Hospital of South Manchester, ATR4, Southmoor Road, Wythenshawe, Manchester, M23 9LT, UK

    Peter Yeates

  3. Manchester Medical School, University of Manchester, Manchester, UK

    Paul O’Neill

  4. Division of Medical Education, Dalhousie University, Halifax, Canada

    Karen Mann

  5. Centre for Health Education Scholarship, Department of Medicine, University of British Columbia, Vancouver, Canada

    Kevin Eva

  6. The Academy at UHSM, 1st floor, ERC, University Hospital of South Manchester, Southmoor Road, Wythenshawe, Manchester, M23 9LT, UK

    Paul O’Neill

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Correspondence to Peter Yeates.

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Yeates, P., O’Neill, P., Mann, K. et al. Seeing the same thing differently. Adv in Health Sci Educ 18, 325–341 (2013). https://doi.org/10.1007/s10459-012-9372-1

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