Exploring Factors that Influence Faculty and Simulated Patients’ Assessment of Student’s Communication Skills during Objective Structured Clinical Examination: A Mixed Methods Study

Simulated patients (SPs) and faculty are integral assessors tasked with grading medical students’ communication skills in objective structured clinical examinations (OSCEs). Understanding their perspectives on this evaluation process is vital for ensuring fairness and impartiality. We conducted a comprehensive analysis, investigating both the quantitative interrater agreement between faculty and trained SPs’ grades on students’ communication skills and qualitatively exploring the factors influencing their grading decisions. Anonymised communication skill grades from 376 students were obtained and analysed. There was a lack of agreement between SPs and faculty grades at different stations. Furthermore, we explored the factors that influence their grading practices through focused group discussions with SPs and faculty examiners. Shared views between SPs and faculty regarding factors influencing grading included the scale of examinations and students’ semesters. Large-scale examinations cause mental fatigue among examiners, and students from higher semesters of study are graded more strictly. The factors that did not influence grading were the course fees, consequences of failing or demotivating students, and examination rules. SPs and faculty held differing views on the influence of their roles and student characteristics, notably grooming and appearance. These disparities expose students to diverse patient perspectives they will encounter in their future roles as healthcare professionals, highlighting the complexity of communication skills assessment in OSCEs and the necessity for a comprehensive approach.