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 assessmentfrom a linguistic and cultural perspective, with a view to understanding why there aresuch 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 RoyalCollege of General Practitioners, they are applicable to many other medical settingswhere standardised examinations of simulated consultations are used. More widely,this research addresses a central paradox in institutional life – how to balance validityin assessments and be fair to a diverse group of candidates in an increasingly diversesociety, while maintaining reliability with standardised and universal marking criteria.It has been widely acknowledged that candidates from overseas fair less well in suchexaminations. A close look at the interactions which make up these simulatedconsultations shows that there are complex and subtle differences between passingand failing candidates which cannot be explained simply as ‘language’ and ‘cultural’differences and put in a box separate from issues of fairness. These structuredexaminations, unintentionally, contribute to the weight of the assessment on overseascandidates, particularly in how interpersonal effectiveness is judged both explicitlyand implicitly.The research has identified a range of successful candidate strategies which formthe basis of a set of e–learning materials to be published by the RCGP. It alsosuggests that aspects of the exam, notably the more subjective features ofinterpersonal skills, are not best assessed in highly structured exams. This area needsto be better defined, using a new analytic language, to debate how and where it couldbe most effectively and fairly assessed