Performance features in clinical skills assessment: Linguistic and cultural factors in the Membership of the Royal College of General Practitioners examination

摘要

This book is based on research looking at performance in clinical skills assessmentudfrom a linguistic and cultural perspective, with a view to understanding why there areudsuch differential pass rates and giving suggestions on how this issue can be tackled.udIt is both a research report and a guide to the sociolinguistic methodology used.udWhile the findings are based on a research project in partnership with the RoyaludCollege of General Practitioners, they are applicable to many other medical settingsudwhere standardised examinations of simulated consultations are used. More widely,udthis research addresses a central paradox in institutional life – how to balance validityudin assessments and be fair to a diverse group of candidates in an increasingly diverseudsociety, while maintaining reliability with standardised and universal marking criteria.ududIt has been widely acknowledged that candidates from overseas fair less well in suchudexaminations. A close look at the interactions which make up these simulatedudconsultations shows that there are complex and subtle differences between passingudand failing candidates which cannot be explained simply as ‘language’ and ‘cultural’uddifferences and put in a box separate from issues of fairness. These structuredudexaminations, unintentionally, contribute to the weight of the assessment on overseasudcandidates, particularly in how interpersonal effectiveness is judged both explicitlyudand implicitly.ududThe research has identified a range of successful candidate strategies which formudthe basis of a set of e–learning materials to be published by the RCGP. It alsoudsuggests that aspects of the exam, notably the more subjective features ofudinterpersonal skills, are not best assessed in highly structured exams. This area needsudto be better defined, using a new analytic language, to debate how and where it couldudbe most effectively and fairly assessed.