This series of blog posts were written by attendees of the JASME Training in Teaching Programme . This is a flexible programme approved for up to 35 CPD hours and is free for individual ASME/JASME members and WP students. It runs on a rolling basis through the year. Please email jasme@asme.org.uk if you are interested in joining.

Student Assessors in Objective Structured Clinical Examinations (OSCEs)
By Robbie Carnegie, Maggie Livingstone, Harrison Loader and Diana Stamatopoulos

4th year students Robbie Carnegie and Maggie Livingstone have recently transferred to the University of Edinburgh from the University of St Andrews. Through peer mentoring with the peer assisted learning scheme (PALS) in St Andrews, the pair developed a keen interest in medical education. Diana Stamatopoulos (5th year), who is also a St Andrews graduate, became interested in medical education when she organised an exam study skills workshop for medical students. Harrison Loader (5th year), who has been at Edinburgh for the duration of the programme, became interested in medical education following involvement in the student orthopaedic society. The authors are currently working toward an Undergraduate Certificate in Medical Education (UGCME). Robbie and Maggie are also completing the JASME Training in Teaching programme. As they progress in their medical education journey and in this blog they contribute to the discussions around the assessment and feedback principles and priorities, from the perspective of medical students as peer assessors.

From early on in their studies, it is understood and emphasised that medical students will adopt the role of an educator during their career. Many medical students get involved in peer teaching through student societies and working with staff, one form this takes is being a peer assessor to support those in earlier years to prepare for their clinical examinations. In this post, we draw on our experiences as medical students and peer assessors to discuss the benefits and challenges of formative peer assessment in OSCEs.

OSCEs are a common method of assessment used by medical schools to assess the skills that written exams are unable to measure, namely clinical and communicational skills and professionalism. The structure of an OSCE typically occurs as multiple stations whereby medical students will undertake a set task in a specified time period, examples include: taking a patient’s medical history, performing an examination, or explaining concepts and diagnoses to patients. Examiners will assess the student’s ability to interact with the patient, perform the task at hand, and comment on their communication and professionalism before determining if they have passed or failed that station.

The Benefits of Student Peer Assessors
OSCE assessors must accurately evaluate and give feedback on an individual’s performance – skills that are not traditionally taught in medical school but are often expected of newly qualified doctors. From our experiences, unconstructive feedback can be frustrating, unmotivating, and purposeless. Therefore, in our role as peer assessors in a basic life support station, when giving feedback we focused on the areas of the ability to work under pressure, the technical aspects of chest compressions and overall communication skills. At the end of the station if time allowed, we would demonstrate good technique in order to give student’s both verbal and visual feedback.

Out with benevolence, learning from peers creates an encouraging learning environment where students can collaborate on ideas and empathise with the struggles of learning topics that they too have recently learnt. Student assessors have a specialist insight into the medical school curriculum through recent lived experience. This means that they can learn from and reflect upon the experiences of one role to another to subsequently improve their performance in both. Running peer assessed OSCEs can increase students’ confidence in a simulated clinical environment and can allow both parties to incorporate the positive aspects of this into their own clinical practice. Through our own experiences we were able to have become more familiar and have confidence with what distinguishes a great performance from a borderline one.

The Challenges of OSCE Peer Assessment
Despite the significance of peer teaching within the medical profession, the role of a student assessors can also pose potential challenges.

  1. Conveying Misleading Information
    Student assessors themselves are still learning and could pose the risk of misinforming other learners, Good Medical Practice 2024 Section 89. It is good practice to take the appropriate steps to ensure the information one communicates is relevant, accurate, and unbiased to avoid any potential negative consequences onto our younger learners. In our experiences, we have always assessed students that are in a year group below ourselves, ensuring that we feel comfortable and well practiced in the skills being assessed. Students were aware of this and we would always introduce ourselves with our full name and current year group Good Medical Practice 2024 Section 83.
  1. Understanding of Assessment Criteria
    Another potential drawback is that students do not know the specifics of assessment criteria and furthermore this may not always firmly align with that used in the summative assessments. This could result in OSCE stations that may not correlate with the appropriate knowledge level expected for the learner’s stage of training and the reinforcement of the wrong aspects of clinical performance. This is made even more difficult by the everchanging medical curriculum and an up to date repertoire of knowledge and skills must be ensured. Being an assessor was the first time we had seen any marking criteria, although likely differing from those used in summative assessment, the categories used to assess performances were ‘below expectation’, ‘meets expectation’ and ‘above expectation’. Whilst the first and second options were easy to distinguish between, we found ourselves rarely selecting ‘above expectation’ as we were unsure what the threshold of this would entail.
  1. Limitations of Students’ Experiences
    As the role of a student assessor has the potential to  mislead the development of the learner, it is important that appropriate steps are taken to limit any negative consequences. A student assessor can mitigate these risks by adhering to this and acting within their competencies, acknowledging their limitations, following guidelines, and seeking senior input when needed. When volunteering as an assessor, we always take steps to familiarise ourselves with the content we know we will be assessing, such as reviewing relevant examination protocols and guidelines to ensure we have up-to-date knowledge. When faced with a concept we were not as confident in, we would acknowledge this, take steps to rectify this or ask to assess another station.

Through appropriate regulation, we can minimise the risk of student assessors misinforming or incorrectly evaluating learners. A proposal to overcome these barriers would be:

  • Provide adequate training and practise for students to become assessors.
  • Ensure quality assurance of student assessors. An initial introduction into a low-stake setting, such as formative assessments of younger years; with the possibility of summative assessments for final year students who have undergone appropriate training and had previous experience.
  • Encouraging students who are passionate and interested in medical education to get involved in order to develop new worthwhile skills and ultimately improve their practice.

The role of a student assessor is not limited to OSCEs but can be extrapolated to anatomy spot tests and multiple mini interviews for medical school applicants. These experiences will not only improve personal performance but will give current student assessors a head start in their medical education journey; an integral part of their future as a doctor regardless of their chosen career path.

References
General Medical Council (GMC) (2024) ‘Good medical practice’. Available at: https://www.gmc-uk.org/-/media/documents/gmp-2024-final—english_pdf-102607294.pdf (Accessed March 2024)

Tags: JASME

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