Background Objective structured clinical examinations (OSCEs) are important aspects of assessment in medical education. There is anecdotal evidence suggesting that students with non-native English accents (NNEA) may be subjected to unconscious bias. It is imperative to minimise the examiners’ bias so that the difference in the scores reflects students’ clinical competence. Research shows NNEAs can cause stereotyping, often leading to the speaker being negatively judged. However, no medical education study has looked at the influence of NNEAs in assessment. Methods This is a randomized, single-blinded controlled trial. Four videos of one mock OSCE station were produced. A professional actor played a medical student. Two near identical scripts were prepared. Two videos showed the actor speaking with an Indian accent and two videos showed the actor speaking without the accent in either script. Forty-two OSCE examiners in the United Kingdom (UK) were recruited and randomly assigned to two groups. They watched two videos online, each with either script, each with a different script. One video with a NNEA and one video was without. Checklist item scores were analysed with descriptive statistics and non-parametric independent samples median test. Global scores were analysed with descriptive statistics and Mann-Whitney test. Results Thirty-two examiners completed the study. The average scores for the checklist items (41.6 points) did not change when the accent variable was changed. Independent samples median test showed no statistically significant relationship between the accent and the scores ( p = 0.787). For the global scores received by the videos with the NNEA, there were one less ‘Good’ grade and one more ‘Fail’ grade compared to those without the NNEA. Mann-Whitney test on global score showed lower scores for videos with NNEA ( p = 0.661). Conclusions Examiners were not biased either positively or negatively towards NNEAs when providing checklist or global scores. Further study is required to validate the findings of this study. More discussion is warranted to consider how the accent should be considered in current medical education assessment. Registration Trial registration completed trial, ID: ISRCTN17360102, Retrospectively registered on 15/04/2020.
Background Formative feedback plays a critical role in guiding learners to gain competence, serving as an opportunity for reflection and feedback on their learning progress and needs. Medical education in Japan has historically been dominated by a summative paradigm within assessment, as opposed to countries such as the UK where there are greater opportunities for formative feedback. How this difference affects students’ interaction with feedback has not been studied. We aim to explore the difference in students’ perception of feedback in Japan and the UK. Methods The study is designed and analysed with a constructivist grounded theory lens. Medical students in Japan and the UK were interviewed on the topic of formative assessment and feedback they received during clinical placements. We undertook purposeful sampling and concurrent data collection. Data analysis through open and axial coding with iterative discussion among research group members was conducted to develop a theoretical framework. Results Japanese students perceived feedback as a model answer provided by tutors which they should not critically question, which contrasted with the views of UK students. Japanese students viewed formative assessment as an opportunity to gauge whether they are achieving the pass mark, while UK students used the experience for reflective learning. Conclusions The Japanese student experience of formative assessment and feedback supports the view that medical education and examination systems in Japan are focused on summative assessment, which operates alongside culturally derived social pressures including the expectation to correct mistakes. These findings provide new insights in supporting students to learn from formative feedback in both Japanese and UK contexts.
BackgroundObjective Structured Clinical Examinations (OSCEs) are important aspects of assessment in medical education. There are anecdotes that students with non-native English accents (NNEA) may be marked negatively due to unconscious bias. It is imperative to minimise the examiners’ bias so that the difference in the scores reflects students’ clinical competence. Research in shows NNEAs can cause stereotyping, often leading to the speaker being negatively judged. However, no medical education study has looked at the influence of NNEAs in assessment.MethodsThis is a randomised, single - blinded controlled trial. Four videos of one mock OSCE station were produced. A professional actor played a medical student. Two near identical scripts were prepared. Two videos showed the actor speaking with an Indian accent and two videos showed the actor speaking without the accent in either script. Forty-two UK OSCE examiners were recruited and randomly assigned to two groups. They watched two videos online, each with either script, with and without the NNEA. Checklist item scores were analysed with descriptive statistics and simple linear regression model. Global scores were analysed with descriptive statistics and logistic ordinal regression model.ResultsThirty-two examiners completed the study. The average scores for the checklist items (41.6 points) did not change when the accent variable was changed. Simple linear regression model showed no statistically significant relationship between the accent and the scores (Regression coefficient = 0.032, p = 0.982). For the global scores received by the videos with the NNEA, there were one less ‘Good’ grade and one more ‘Fail’ grade compared to the ones without the NNEA. Logistical ordinal regression model on global scores showed, examiners were more likely to mark the student more negatively (p < 0.0001) but also more positively (p < 0.0001) when the NNEA was present.ConclusionsExaminers could be biased either positively or negatively towards NNEAs when giving global scores. Further research is required to consider the nature of this bias. More discussion is warranted to consider how the accent should be considered in current medical education assessment.
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