Dundee ASSESS: tips on using domain-based grading to enhance the validity, student feedback and educational impact of the OSCE

The way an assessment is scored can significantly impact an educational program by influencing the behavior of learners and imposing structure and direction on teachers and assessors. Some scoring systems for the objective structured clinical examination (OSCE), such as a checklist format, provide psychometric benefits of reliability and perceived objectivity but can also encourage formulaic learning that can impede the development of true clinical expertise, negatively impacting assessment validity. The structure of the scoring systems can also restrict the application of expert judgement and impact feedback to learners. Domain-based systems can potentially address these issues. We developed a domain-based tool to reflect the essential qualities of a well-prepared clinician, that is, they are accurate (do the right thing); skilful (perform tasks in a skilled manner); supportive (to patients, relatives, and colleagues); efficient and structured (display an appropriate level of control in a well-organized encounter); and safe (for patients, self, and others). This tool is abbreviated ASSESS. We believe that the ASSESS scoring system encourages clinically relevant behaviors within a patient encounter, enhances feedback, aligns with national and educational strategies, and positively affects our clinical curriculum. However, this approach has limitations, particularly for clinical tasks that do not involve interactions with a patient. Having run this domain-based scoring system for the last 12 years, we provide tips from the lessons learned by creating a simple and generic structure for domain-based grading, yet one that has a significant underlying nuance and complexity. We acknowledge that the assessment of preparedness for clinical practice cannot be achieved with a ‘one-size-fits-all’ approach but encourages the healthcare educational community to further research the impact of alternative scoring systems.