Adapting to Adaptive Learning Technology

by Endya L. Young, PharmD, PGY1 Pharmacy Practice Resident, Magnolia Regional Health Center

While humans tend to be alike in more ways than not, we are also very different. We differ in the ways we think, feel, and act. And we differ in the ways we learn. Students each have their own learning style, strengths, and weaknesses that do not always align with a “one size fits all” approach. What if there was a technology to meet the different needs of students? What if this technology had the potential to foster self-directed learning skills? Such a technology would be a great addition to health professions curricula in combination with other teaching methods. This technology exists today!  Although it is fairly new, the technology has the potential to provide some significant benefits to students in the long run.

What is adaptive learning technology (ALT)? It is computer-based software that provides a personalized learning experience based on how the student performs.¹ It allows the student’s learning experience to be navigated in a way that fits the student’s needs and increases the likelihood that the student will be successful.² How does this work? ALT modifies the student’s learning materials in real-time based on their interaction with the program.³ Based on the student’s responses, ALT identifies the student’s strengths and address weaknesses and then adjusts the instructional materials, changes the pace, modifies the assessments, or provides feedback specific to the learner’s needs. ALT provides an efficient and flexible way to remediate learners who have not yet mastered a lesson while presenting new information to those who have.⁴

The number of studies on the effectiveness of adaptive learning technologies in pharmacy curricula is limited, but I believe it could be of significant benefit to students.  Using adaptive learning technology would prompt students to further develop their self-directed learning and their independence when learning — skills they need after they graduate. It has the potential to reduce gaps in learning and help to identify students who may be struggling.⁴ Use of this technology in pharmacy schools seems promising because of the need to retain the foundational knowledge while acquiring new information from the ever-evolving, ever-changing world of healthcare.

A recent study analyzed changes in self-directed learning when adaptive learning technology was used. This study enrolled first-year pharmacy students who were completing a two-semester Pharmacists’ Patient Care Process (PPCP) course series.³ In the first semester of this course, professors used active learning during traditional lectures, for example requiring students to complete pre-readings and reflections on course content followed by in-class quizzes.³ Adaptive learning technology was then used during the second semester of the course. Students were required to complete midterm and final examinations in both semesters. Surveys were completed by the students to assess the following: assignment management, stress management, procrastination management, seminar (lecture) learning proficiency, comprehension competence, examination management, and time management.³ To measure the students’ experiences and perceptions of ALT, focus groups were also used to gather additional feedback. The investigators report that students appreciated the additional practice and assessments that ALT provided. The study also concluded that using ALT freed up time during class for the instructors and students to engage in more active learning activities.

The themes identified from the student focus groups in this study convinced me that adaptive learning technology is something that should be incorporated into the pharmacy curriculum. The first theme was student learning preferences. Students overall found the assessments in ALT to be helpful, but also stated that the use of this technology made it more difficult to study for examinations.³ The students in this group stated that they would have liked to have some sort of guide such as PowerPoint slides to aid them in identifying the most pertinent information. The second theme mentioned was teaching methods. Students liked the mix of the teaching methods used, such as pre-class activities, mini-lectures to highlight key points in the learning material, and in-class activities to reinforce their learning.³ It is important to note that some students did not engage with ALT as they should have, often only answering the assessment questions and bypassing course material.  This is important because another study that used ALT in a physics course at a South African University found that students who spent more time engaging with the program performed better on examinations.⁵ The third theme was valued. Students seemed to benefit more from hearing their professor’s insight on the material being taught and helped them to apply concepts as they progressed. The fourth theme was technology and the challenges the students encountered with its use.

Although the findings in this particular study showed that the use of ALT was not favored by most students, I think that some of the student’s concerns are due to a lack of familiarity. Their desire to be given notes and the fact that many students struggled with procrastination and time management makes me think they oppose ALT simply because it is not something they have used before and have not yet developed the skills to be self-directed learners. Students may have had difficulties because they the lack skills needed to discern important information on their own.³ They preferred to have all of the information provided to them and to have the teacher point out what is important during class. Some students also did not engage with the ALT as they should have, often prioritized other classes. Using a combination of in-class active learning activities with ALT in between class sessions, in my opinion, gives the students the opportunity to learn from and engage with the professor but also develop life-long learning skills.  This will require some major adjustments for student students (and instructors!). Such a major change should be introduced gradually. Overall, I believe ALT has great potential – helping students who have not yet mastered the material a personalized experience while simultaneously promoting the development of self-directed learning skills. 

References

1. Forsyth B, Kimble C, Birch J, Deel G, Brauer T. Maximizing the Adaptive Learning Technology Experience. Journal of Higher Education Theory and Practice [Internet]. 2016;16(4):80-88.
2. Liu M, Kang J, Zou W, Lee H, Pan Z, Corliss S. Using Data to Understand How to Better Design Adaptive Learning. Technology, Knowledge and Learning. 2017;22(3):271–98. 
3. Toth J, Rosenthal M, Pate K. Use of Adaptive Learning Technology to Promote Self-Directed Learning in a Pharmacists’ Patient Care Process Course. American Journal of Pharmaceutical Education [Internet]. 2020;85(1): Article 7971.
4. Moskal P, Carter D, Johnson D. 7 Things You Should Know About Adaptive Learning [Internet]. EDUCASE 2017.
5. Basitere M, Ivala E. Evaluation of an adaptive learning technology in a first-year extended curriculum programme physics course. South African Computer Journal; 2017; 29 (3):1-15.

The Role of Peer Instruction in Health Professions Education

by Whitley Tassin, MBS, PharmD, PGY1 Pharmacy Practice Resident, University of Mississippi Medical Center

Instructors are always looking for methods to improve student participation and engage learners in the classroom. Multiple methods have been proposed including pop quizzes, audience response systems, small group discussion, group work, case vignettes, and more. But what is the evidence to support these methods and what are the best methods to engage learners? In recent years, peer instruction has gained increasing support and has become widely used in undergraduate education in an effort to not only engage students but, most importantly, improve learning.¹ Multiple methods of peer instruction have been developed and there are subtle differences between each of these methods.  Table 1 below describes the different peer instruction methods.

Table 1: Types of Peer Instruction¹

Term	Definition
Peer Teaching	Learners with similar levels of expertise and from comparable social groups (but who are not professional teachers) assist each other to learn and learn by teaching
Peer Modeling	The teacher provides (or points out) a competent exemplar(s) by a learner(s) in the group with the purpose that others will emulate these examples
Peer Education	Learners share information and talk about attitudes or behaviors with the goal of educating people, clarifying general life problems, and identifying solutions
Peer Monitoring	Learners observing and checking to determine if their partners/peers are engaged in appropriate and effective processes for learning and studying
Peer Assessment	Learners provide feedback or score/grade (or both) their peers’ performance based on a set criteria

 

While these tactics have been employed across various disciplines, few have been studied in pharmacy education. However, the literature consistently points to the positive impact that peer instruction has had on improving learning outcomes.

One study at Cedarville University looked at the effect of peer instruction in a self-care course within a Doctor of Pharmacy program.² Peer instruction was employed for seven topics: constipation and anorectal disorders; nausea, vomiting, and diarrhea; allergies; cough and cold; fungal and wounds; ophthalmic, otic, and oral; and dermatitis and sun care. Students were asked to prepare for each topic before class in anticipation of a “quiz” given on each topic. They were paired with a peer to discuss each topic after the quiz. If the average was above 70%, this indicated that most students had a good understanding of the concept, and discussion was not needed. When a score fell below 30%, this indicated that most students did understand of the topic, and the instructor provided additional instruction about the concept. If the score was between 30% and 70%, students would then engage in a discussion about their answers.  Students were instructed to justify their answers to their peers. Following this brief period of peer instruction, the questions were again presented to the class and scored. Results showed that scores improved significantly for each topic when peer instruction was implemented. In addition, students were asked to voluntarily complete a survey about their opinions and experiences with peer instruction. More than 80% of students responded to the survey and the results suggested that students felt very positive about peer instruction. Students reported that defending their thoughts was beneficial and that peer instruction reduced the awkwardness and “embarrassment” of approaching a professor with a question. They also reported that they enjoyed discussing concepts with their classmates and that they would like to see this technique used more frequently and in other courses.

Another study at the University of California San Francisco looked at the effectiveness of peer instruction in a pharmacology course taught by pharmacy students to physical therapy students.³ Physical therapy students were instructed to review pre-recorded lectures prior to attending class and take quizzes on the material. Under the mentorship of a faculty member, all lectures, quizzes, cases, and final assessments were developed by pharmacy students. In-class sessions consisted of working in small groups and then presenting what was discussed to the larger group. Pharmacy students served as teaching assistants and were present to answer questions and facilitate discussion. When surveyed at the end of the course, physical therapy students reported that they felt that learning about other healthcare professions from someone outside of their discipline was beneficial and it increased their comfort interacting with other members of the healthcare team. This demonstrates that peer instruction improves student’s learning and can also be a potential tool to increase interprofessional interaction.

What are some best practices that faculty should follow if they wish to use peer instruction in their classes? A recently published scoping review sought to determine the best methods for peer instruction, identify barriers to implementation, and student perceptions of peer instruction in pharmacy education.¹ The results suggested there was a positive impact on learning and feedback from students was positive regardless of what type of peer instruction was used. Using both quantitative and qualitative survey methods, students in the included studies reported that participating in peer instruction would likely result in a higher grade and they are open to using this learning method more often. Students also reported that peer instruction challenged them to think critically, defend answer choices, and discuss aspects of the topic they might not have otherwise considered.^1,2

While peer instruction has several potential benefits, faculty should be aware of the potential barriers when implementing this teaching strategy. It is important to train peers instructors and reviewers. If the peer instructor doesn’t have a good understanding of the topic, this can lead to misinformation and would obviously negatively impact student learning. In addition, when peer assessment is used, the students giving feedback must have very clear guidelines or rubrics that should be used when delivering feedback. Peer reviewers should receive training not only on the appropriate use of the rubric but also on how to effectively deliver constructive feedback. Thus, students who are actively teaching or leading any portion of peer instruction must receive proper training in order for the program to succeed.¹  This requires the teacher to spend an adequate amount of time and energy developing train-the-trainer materials.

Overall, the results of numerous studies demonstrate that peer instruction can have many beneficial effects. Implementing peer instruction throughout the curriculum can increase student engagement, improve learning outcomes, and build important critical thinking skills.

References

1. Aburahma M, Mohamed H. Peer Teaching as an Educational Tool in Pharmacy Schools; Fruitful or Futile. Currents in Pharmacy Teaching and Learning [Internet]. 2017; 9(6): 1170-1179.
2. Straw A, Wicker E, Harper N. Effect of Peer Instruction Pedagogy on Concept Mastery in a First Professional Year Pharmacy Self-Care Course. Currents in Pharmacy Teaching and Learning [Internet]. 2021; 13(3): 273-278.
3. Hsia S, Tran D, Beechinor R, et al. Interprofessional Peer Teaching: The Value of a Pharmacy Student-led Pharmacology Course for Physical Therapy Students. Currents in Pharmacy Teaching and Learning [Internet]. 2020; 12(10): 1252-1257.

Accelerated Curriculums: Potential Benefits … and Harms

by Brett Lambert, PharmD, PGY1 Pharmacy Practice Resident, North Mississippi Medical Center

For those looking to pursue a career in pharmacy or other health professions, the decision as to which school to attend is often based on a few key factors. Important factors applicants typically assess include the duration of the program, the passage rates on licensure exams, the quality of the education, the benefit to their career, and the memories that can be made with peers or the quality of the social life. Some colleges/schools offering an accelerated program and prospective students are left to consider the benefits of completing their desired curriculum faster than normal. It is therefore important to consider the potential benefits (and harms) of completing an accelerated curriculum.

Accelerated programs provide an opportunity for students to complete their preferred professional program in a shorter period of time than a normal curriculum length. For pharmacy schools, this means students complete their doctoral degree in three years rather than the usual four years. To accomplish the same curriculum in 3 years, accelerate program conduct classes year-round without end of semester breaks like summer or winter break. According to the American Association of Colleges of Pharmacy, as of July 2020, there are a total of 142 colleges or schools of pharmacy.¹ Of these schools, there are at least fifteen programs that offer an accelerated Pharm.D. curriculum.

One way to determine if accelerated programs are as good or, perhaps, superior to traditional programs is to compare pass rates on the licensure exam.  In pharmacy, the NAPLEX (North American Pharmacist Licensure Examination) is required to become a pharmacist.  The NAPLEX first attempt passage rates from the past three years (2017,2018, and 2019) for the fifteen accelerate programs were substantially lower than the national average passage rate. Using data reported by the National Association of Board of Pharmacy,² accelerated programs averaged a passage rate that was 3-5% lower than the average national passage rate.

While this data is not a full analysis of the data available, it does provide some insight as to how these programs compare to the traditional four-year programs. However, the length of the curriculum is but one factor and there are other factors that could affect NAPLEX pass rates. One of which is the age (or maturity) of the program. In a recent survey that examined pharmacy school characteristics and their first-time NAPLEX pass rates, pharmacy schools established before 2000 had significantly higher first attempt pass rates on the NAPLEX than those established after.³ Thus historic (or more mature) programs seem to produce students better prepared to pass the NAPLEX on the first attempt. The authors also reported that between 2015 and 2016 when the NAPLEX testing structure was changed, a smaller percentage of four-year programs experienced a 10% or greater decrease in first-time pass rates than three-year accelerated programs (c²=5.54, p=.02).³ The pass rate dropped from 92.5 to 86.6 among traditional four-year programs and from 90.2 to 80.4 in three-year accelerated programs.  This difference was significant.³

Another study compared the length of advanced pharmacy practice experiences (APPE) to determine the correlation with first-time pass rates. The lengths of the APPEs included four, five, or six-week blocks.⁴ However, the results provide no evidence that APPE rotation length correlated with a higher first attempt pass rate for the NAPLEX. This would argue that the length of clinical rotations does not affect a student’s ability to pass the NAPLEX.

One metric that some programs use to boast about the quality of graduates they produce is the number of students that match with PGY-1 and PGY-2 residency programs. According to the National Matching Service, the official matching program for PGY-1 and PGY-2’s, in 2020 there was a total of 7535 students who registered for the match and 3904 who matched; which is a 51.8% match rate for all programs. The 15 three-year programs had a match rate of 39.7% compared to a 53.1% match rate for four-year pharmacy programs.⁶

Another difference between programs of different lengths that is more difficult to quantify is the impact an accelerated curriculum might have on a student’s social life. A curriculum that completely consumes a student’s life and does not allow enough time to get involved in professional or social organizations, maintain hobbies, or spend time with family reduces opportunities for a healthy social life. These barriers to social and professional development could affect the student’s interactions with patients, peers, or co-workers.

Given the potentially negative consequences of accelerated curriculum, why would any student consider applying to or attending such a program? The most obvious benefit is that by graduating a year early the student enters practice a year sooner – which translates in an extra year of work, an extra year of practical experience as a pharmacist, and can lead to an improved financial situation in both the short and long-term. However, there is no promise of a better job, career, or future opportunities.

The debate about accelerated professional programs is not unique to pharmacy — the medical professional is now deliberating the merits of accelerated medical school programs. Recently, there have been medical school programs that are reviving a three-year program structure. These three-year accelerated programs originated during WWII when there was a shortage of physicians.⁵ Once the war was over, the students who graduated from the accelerated programs felt the need for more courses.⁵ Which suggests that graduates from these accelerated programs didn’t feel fully prepared despite the fact that they received on-the-job experience. Surprisingly, these three-year programs were not discontinued due to lower pass rates of the USMLE (the United States Medical Licensing Examination) compared to those of four-year programs. Indeed, there are no differences between the pass rates based on program length.⁵

It seems to me that when designing a program and teaching students, there needs to be time for the information to sink in. The literature suggests that out-of-class learning, including extra-curricular activities, can be very beneficial to one's career. This includes building leadership skills through service in professional organizations and developing social skills.  Students also need time to think deeply about the material covered in class. There are many factors that influence licensure pass rates, but I don’t think we know yet the key ingredients to creating a shorter curriculum that is equally effective.

References

1. Academic Pharmacy's Vital Statistics. American Association of Colleges of Pharmacy. Published July 2020. Accessed February 20, 2021.
2. North American Pharmacist Licensure Examination Passing Rates for 2017—2019 Graduates Per Pharmacy School. National Association of Board of Pharmacy. Published February 25, 2020. Accessed February 20, 2021.
3. Williams JS, Spivey CA, Hagemann TM, Phelps SJ, Chisholm-Burns M. Impact of Pharmacy School Characteristics on NAPLEX First-time Pass Rates. Am J Pharm Educ. 2019;83(6):Article 6875.
4. Ried LD. Length of advanced pharmacy practice experience and first-time NAPLEX pass rate of US pharmacy programs. Curr Pharm Teach Learn. 2020;12(1):14-19.
5. Schwartz CC, Ajjarapu AS, Stamy CD, Schwinn DA. Comprehensive history of 3-year and accelerated US medical school programs: a century in review. Med Educ Online. 2018;23(1):1530557
6. NUMBER OF APPLICANTS APPLYING FOR PGY1 PROGRAMS BY SCHOOL 2020 MATCH – COMBINED PHASE I AND PHASE II. National Matching Services. Published 2020. Accessed April 1, 2021.

Beware! Teacher’s Bias and Favoritism

by Mariah Cole, PharmD, PGY1 Community Pharmacy Practice Resident, Mississippi Department of Public Health

“Ugh, ____ is such a teacher’s pet.”

Does this ring a bell for you? The teacher’s pet was a title given to any student who had a “preferential” relationship with the teacher. What does the teacher’s pet relationship look like? The teacher's pet could be the child who was consistently picked to pass out papers or lead the lunch line. It wasn’t just the most helpful students but the “smart” students as well. The “smart” students seemed to know the answers to all the questions asked during class or were consistently recognized by the teacher for scoring the highest on quizzes or tests. Not every student called a “teacher’s pet” was actually given any form of favoritism. None-the-less, such preferential treatment can have a positive effect on students. But just as importantly, favoritism impacts the rest of the students in class.  Thus, teachers need to be mindful of how their relationships with students are perceived.

Teachers and students are human and subject to bias, whether intentional and/or unintentional.  This trickles into their interactions with and among each other.¹ Bias arises from both positive and negative attitudes towards people based on their socio-cultural and economic background, gender, and many other factors. For example, students or teachers from differing geographical regions may experience bias due to beliefs about regional dialects or accents. And bias can lead to barriers to effectively working together.¹ In addition, teachers and students may have interfering dynamics that arise during interactions such as approval seeking, competition, excessive dependency, and psychological withdrawal or reactance.¹ Thus bias and interfering dynamics culminate in favoritism, neglect, or prejudicial actions towards others.

Teacher favoritism may be defined as “the act of giving preferential treatment to someone or something; the tendency to favor a person or group for factors “such as a characteristic they possess, or their personal contacts, or merely out of personal preferences”.¹ Thus, the “teacher pet” relationship is a type of teacher favoritism. It may be noted that there are various definitions within the literature for the “teacher pet” relationship. One author defines it as, “a phenomenon of a special emotional relationship (often a love relationship) between the teacher and a particular student (or two) in the classroom.”¹ Meanwhile, another author defines the concept as “student favored by teachers because they have actual and/or alleged characteristics that are highly valued by teachers but not necessarily by classmates.”¹ Favoritism may also manifest from teachers’ affectionate ties to a student, which derive from the pleasure that the student brings to the teachers’ work.² One study characterized teacher’s pets are more likely to be girls who come from higher socioeconomic backgrounds but may not be considered the best academic students.²

While overt favoritism toward particular students may not be seen in the same way in college and professional degree programs, the mentoring relationship has the potential to be interpreted as a teacher’s pet or favoritism relationship. A few students, by virtue of their background or preferential characteristics, are given more access to the instructor or professor and are given opportunities not afforded to other students.  The development of a friendship may complicate or compromise the mentoring relationship. One author notes that a professional mentor is a position of power. Thus, a hierarchy should predominate and the mentor should not be considered equal to the mentee. For this reason, a friendship-type relationship should never be established during the mentorship period.³  This is not to say that mentors should not act in a friendly, helpful manner to mentees and that these relationships should not have a personal dimension.⁴ Befriending mentees increases the psychosocial support provided to students. However, befriending is not equivalent to friendship. Befriending is about building a positive relationship that is collegial.  Thus, the mentoring relationship can still be cordial, personal, and enjoyable.

As the mentoring relationship progresses, the relationship should evolve. Setting clear expectations of the relationship at the beginning may increase the effectiveness of the mentoring relationship. Heidrun Stoegar explains “effective mentoring relies on mentors and mentees having clear ideas about what mentoring entails, how it is distinct from other support measures, and what expectations for a given mentoring experience are realistic”.⁵ One method of setting expectations includes creating a mentoring contract which would include “defining relationship’s boundaries, reduce confusion about roles and expectations, clarifies commitments including time, and defines relationship’s objectives. However, making formal contracts may stifle informal support”.^6,7 Thus, a conversation about expectations, rather than a written contract, is probably more appropriate.

Favoritism is cultivated by our conscious and unconscious biases. Bias may lead to positive and negative attitudes toward various groups of students and differences in the way they are treated. Favoritism may manifest within undergraduate, professional, and graduate education in the form of mentoring. If the boundaries of the mentoring relationship cross into friendship, students may interpret this relationship as favoritism. Setting boundaries and expectations can help prevent perceptions of favoritism and maintain a professional relationship with all learners.

References

1. Cheng E. Teacher Bias and Its Impact on Teacher-Student Relationships: The Example of Favoritism [Internet]. [cited 2021Mar8].
2. Tal Z, Babad E. The teacher’s pet phenomenon: Rate of occurrence, correlates, and psychological costs. Journal of Educational Psychology. 1990;82(4):637–45.
3. Detsky AS, Baerlocher MO. Academic mentoring--how to give it and how to get it. JAMA. 2007;297(19):2134–6.
4. Mullen CA, Klimaitis CC. Defining mentoring: a literature review of issues, types, and applications. Annals of the New York Academy of Sciences. 2021;1483(1):19–35.
5. Stoeger H, Balestrini DP, Ziegler A. Key issues in professionalizing mentoring practices. Annals of the New York Academy of Sciences. 2021 Jan 1;1483(1):5–18.
6. MacLeod S. The challenge of providing mentorship in primary care. Postgrad Med J. 2007 May;83(979):317-9.
7. Burgess A, van Diggele C, Mellis C. Mentorship in the health professions: a review. Clin Teach. 2018 Jun;15(3):197-202.

Should Standardized Patients Score Student Performance?

by Ashley Miller, PharmD, PGY1 Community Pharmacy Resident, University of Mississippi School of Pharmacy

It's the end of the semester, and the last thing standing between you and your summer break is the objective structured clinical examination (OSCE). You know that you’ll be entering multiple interactive stations that will assess your ability to perform patient care-related activities. Who do you hope will be grading your performance – a teacher you’ve had, or a stranger — a standardized patient (SP)? I know what I preferred when I was the one undergoing these evaluations, but I was curious to learn more about what other professional students, faculty, and researchers had to say about who is the best person to evaluate and score a student’s performance.

OSCEs date back to the 1960s and were first used as assessments in medical schools.  Each OSCE station is intended to represent a realistic clinical scenario during the student interacts with a “patient.”^1,2  At many schools, the patient role is played by an experienced actor known as a standardized patient (SP).  An OSCE allows students to "practice" in an environment safe for both them and patients.¹ OSCEs are reliable and valid assessment tools and predict students' future success.^1,2  Their use was expanded to other health professional programs including dentistry, pharmacy, and nursing.^1,2 They were designed to comprehensively evaluate clinical, interpersonal, and problem-solving skills and consistently portray the clinical scenario so that every student has the same experience (and opportunities).^1,3 While preparing and delivering an OSCE is very time-consuming, both educators and students alike agree that OSCEs are a valuable learning and assessment tool.³

One thing not always agreed upon when considering OSCEs is whether a faculty member or SP should grade performance. In some instances, an SP may interact with the student while a faculty member grades the interaction while observing the encounter either remotely or in the same room. Some argue that having faculty graders introduces additional bias and negatively influences students' performance when compared to a more neutral grader.³ Others claim SPs do not have the skillset or training needed to properly assess students.³ Previous studies involving faculty versus SP graders have not provided a clear answer as to who makes the “best” grader.

Different evaluator factors contribute to variability when scoring OSCE encounters, including lack of defined criteria, lack of training, and the number of items to be assessed.⁴  One study looked at factors that affected student scores during an OSCE when evaluated by faculty versus SPs.⁴ Before grading began, all examiners were first put through a series of training on the OSCE process and the criteria they were to use for scoring students.⁴ The researchers found that the scores given by SPs were higher than those given by faculty members, suggesting that the type of grader does influence scores.⁴ Another interesting finding was that the faculty evaluators assessed technical skills more strictly, yet were not as strict when grading communication skills when compared to SP evaluators.⁴ The technical skills assessed included history-taking, physical examination, and patient education.⁴ Communication skills that were graded include the attitude of the student, active listening, ability to build rapport, and effective questioning.⁴ Notably, faculty members who were scoring items related to their specialty tended to assign lower grades.⁴ The authors hypothesized that these differences are seen because faculty graders are more familiar with assessing the technical skills (particularly if it was relevant in their specialty) and have higher expectations for performance, while SPs are not as comfortable giving lower scores on technical matters.⁴

While some faculty members believe that their presence does not impact student performance, students often report that knowing teachers are grading OSCEs increases testing anxiety.³ The increased stress then impacts performance which, in turn, affects students’ grades.^3,4 In a study conducted using student questionnaires to survey the use of SP versus faculty graders, McLaughlin et al. found that the majority of students felt SPs helped create a less stressful testing environment, were as good at giving feedback as faculty graders, and felt they were adequately equipped to assess their skills.² The findings of this study demonstrate that students generally prefer to be graded by an SP and believe that an SP can competently assess their performance.²

So, who should grade a student’s performance during an OSCE? It likely depends on who you are asking. Overall, it seems that most students feel SPs are equipped for the task, are fair graders, and help them to feel more at ease. Much like how I felt when I was a student, it seems students would prefer an SP in these encounters since it is a more realistic experience — similar to interacting with patients in the “real world.”³  However, some may contend that, while students may not be as comfortable, having professors performing the assessment is in the student's best interest long-term because they can more accurately assess the student’s technical skill. One point made for this argument is that some studies have shown that grades given by faculty are predictive of future performance.² Another point made by researchers and those in academia for having faculty graders is that they are content experts and may be able to identify students who have only surface-level knowledge but appear confident and skillful to a non-expert.² It is also possible to have SPs interact with the students while faculty members observe and grade the encounter synchronously or asynchronously.  In this way, the student performance is scored by both the SP and faculty members.  However, this would cost more time and money as both SPs and faculty would need to be trained. Research shows SPs focus more on communication while faculty focus more on technical skills in an encounter, thus, it may come down to the most important skill being assessed in a particular OSCE station when choosing who should score it.

^References 

1. Alsaid A, Al-Sheikh M. Student and Faculty Perception of Objective Structured Clinical Examination: A Teaching Hospital Experience. Saudi J Med Med Sci [Internet]. 2017;5 (1):49-55.

2. McLaughlin K, Gregor L, Jones A, et al. Can SPs Replace Physicians as OSCE Examiners? BMC Med Educ [Internet]. 2006;6: Article 12. 

3. Salinitri FD, O’Connell MB, Garwood CL, et al. An Objective Structured Clinical Examination to Assess Problem-Based Learning. Am J Pharm Educ [Internet]. 2012;76(3): Article 44. 

4. Park YS, Chun KH, Lee KS, et al. A Study on Evaluator Factors Affecting Physician-Patient Interaction Scores in Clinical Performance Examinations: A Single Medical School Experience. Yeungnam Univ J Med 2021;38(2):118-126.