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

Abstract

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