The hidden labours of designing the Objective Structured Clinical Examination: a Practice Theory study
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The hidden labours of designing the Objective Structured Clinical Examination: a Practice Theory study Margaret Bearman1 · Rola Ajjawi1 · Sue Bennett2 · David Boud1,3,4 Received: 5 March 2020 / Accepted: 3 November 2020 © Springer Nature B.V. 2020
Abstract Objective Structured Clinical Examinations (OSCEs) have become ubiquitous as a form of assessment in medical education but involve substantial resource demands and considerable local variation.A detailed understanding of the processes by which OSCEs are designed and administered could improve feasibility and sustainability. This exploration of OSCE design is informed by Practice Theory, which suggests assessment design processes are dynamic, social and situated activities. The overall purpose is to provide insights that inform on-the-ground OSCE administration. Fifteen interviews were conducted with OSCE academics and administrators from three medical schools in Australia, the United Kingdom and Canada. Drawing from post-qualitative inquiry, Schatzki’s Practice Theory was used both as a sensibility and as an analytic framework. OSCE design was characterised by planning activities, administration activities, negotiation activities and bureaucratic activities; it involves significant and resource-intensive effort in negotiation and coordination. There was considerable local variation but at the same time activities were remarkably consonant across national boundaries. There was a tension between general understandings such as reliability and validity that underpin the OSCE and the improvisational practices associated with design and administration. Our findings highlighted the role of blueprints as a key coordinating artefact but with too many rules and procedures prompting cycles of bureaucracy and complexity. Emphasising coordination rather than standardisation might ease workloads, support adaptation to local environments and prevent an overly reductive approach to this assessment format. Keywords Sociomateriality · Practice theory · OSCE · Assessment design
* Margaret Bearman [email protected] 1
Centre for Research in Assessment and Digital Learning (CRADLE), Deakin University, Geelong, Australia
2
School of Education, University of Wollongong, Wollongong, Australia
3
Faculty of Arts and Social Sciences, University of Technology Sydney, Ultimo, Australia
4
Centre for Research on Work and Learning, Middlesex University, London, UK
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Introduction The Objective Structured Clinical Examination (OSCE) holds a taken-for-granted place in the global medical education landscape. Medical schools, national licensing organisations, and specialty training colleges utilise OSCEs as a defensible means to assess clinical skills outside of the unpredictable clinical environment. However, administering OSCEs is highly complex (Patrício et al. 2013) and expensive (Craig Brown et al. 2015). Developing an OSCE is not simply another form of assessment design. It involves many academics, clinicians, administrator
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