title: Should non-expert clinician examiners be used in objective structured assessment of communication skills among final year medical undergraduates?
abstract: BACKGROUND
  Adoption of the objective structured clinical examination may be hindered by shortages of clinicians within a specialty. Clinicians from other specialties should be considered as alternative, non-expert examiners.
  
  
  OBJECTIVE
  We assessed the inter-rater agreement between expert and non-expert clinician examiners in an integrated objective structured clinical examination for final year medical undergraduates.
  
  
  METHODS
  Pairs of expert and non-expert clinician examiners used a rating checklist to assess students in 8 oral communication stations, representing commonly encountered scenarios from medicine, paediatrics, and surgery. These included breaking bad news, managing an angry relative, taking consent for lumbar puncture; and advising a mother on asthma and febrile fits, and an adult on medication use, lifestyle changes and post-suture care of a wound. 439 students participated in the OSCE (206 in 2005, 233 in 2006).
  
  
  RESULTS
  There was good to very good agreement (intraclass coefficient: 0.57-0.79) between expert and non-expert clinician examiners, with 5 out of 8 stations having intraclass coefficients > or =0.70. Variation between paired examiners within stations contributed the lowest variance to student scores.
  
  
  CONCLUSIONS
  These findings support the use of clinicians from other specialties, as 'non-expert' examiners, to assess communication skills, using a standardized checklist, thereby reducing the demand on clinicians' time.
authors.affiliation: Department of Community, Occupational and Family Medicine, Yong Loo Lin School of Medicine, National University of Singapore. cofwml@.nus.edu.sg
authors.forename: Mee Lian
authors.initials: ML
authors.lastname: Wong
authors.forename: Calvin S L
authors.initials: CS
authors.lastname: Fones
authors.forename: Marion
authors.initials: M
authors.lastname: Aw
authors.forename: Chay Hoon
authors.initials: CH
authors.lastname: Tan
authors.forename: Poh Sim
authors.initials: PS
authors.lastname: Low
authors.forename: Zubair
authors.initials: Z
authors.lastname: Amin
authors.forename: Poo Sing
authors.initials: PS
authors.lastname: Wong
authors.forename: Poh Sun
authors.initials: PS
authors.lastname: Goh
authors.forename: Chun-Tao
authors.initials: CT
authors.lastname: Wai
authors.forename: Benjamin
authors.initials: B
authors.lastname: Ong
authors.forename: Paul
authors.initials: P
authors.lastname: Tambyah
authors.forename: Dow Rhoon
authors.initials: DR
authors.lastname: Koh
mesh_terms: D002983:Clinical Competence / Q000592:standards*; D003142:Communication; D004504:Education, Medical, Undergraduate / Q000592:standards*; D004521:Educational Measurement / Q000379:methods* / Q000592:standards; D005180:Faculty, Medical / Q000592:standards / Q000600:supply & distribution; D006801:Humans; D015588:Observer Variation; D010865:Pilot Projects; D015203:Reproducibility of Results