title: Changing Objective Structured Clinical Examinations Stations at Lunchtime During All Day Postgraduate Surgery Examinations Improves Examiner Morale and Stress.
abstract: BACKGROUND
  Human factors are important causes of error, but little is known about their possible effect during objective structured clinical examinations (OSCE). We have previously identified stress and pressure in OSCE examiners in the postgraduate intercollegiate Membership of the Royal College of Surgeons (MRCS) examination. After modifying examination delivery by changing OSCE stations at lunchtime with no demonstrable effect on candidate outcome, we resurveyed examiners to ascertain whether examiner experience was improved.
  
  
  METHODS
  Examiners (n = 180) from all 4 surgical colleges in the United Kingdom and Ireland were invited to complete the previously validated human factors questionnaire used in 2014. Aggregated scores for each of 4 previously identified factors were compared with the previous data. Unit-weighted z-scores and nonparametric Kruskal-Wallis methods were used to test the hypothesis that there was no difference among the median factor z-scores for each college. Individual Mann-Whitney-Wilcoxon tests (with appropriate Bonferonni corrections) were used to determine any differences between factors and the respective colleges.
  
  
  RESULTS
  141 Completed questionnaires were evaluated (78% response rate) and compared with 108 responses (90%) from the original study. Analysis was based on 26 items common to both studies. In 2014, the college with the highest candidate numbers (England) was significantly different in 1 factor (stress and pressure), compared with Edinburgh (Mann-Whitney-Wilcoxon: W = 1524, p < 0.001) and Glasgow colleges (Mann-Whitney-Wilcoxon: W = 104, p = 0.004). No differences were found among colleges in the same factor in 2016, Kruskall-Wallis: (χ2(3) = 1.73, p = 0.63). Analysis of responses found inconsistency among examiners regarding mistakes or omissions made when candidates were performing well.
  
  
  CONCLUSIONS
  After making changes to OSCE delivery, factor scores relating to examiner stress and pressure are now improved and consistent across the surgical colleges. Stress and pressure can occur in OSCE examiners and examination delivery should ideally minimize these issues, thereby improving morale is also likely to benefit candidates.
authors.affiliation: ICBSE, The Royal College of Surgeons of England, London, United Kingdom. Electronic address: Peter.brennan@porthosp.nhs.uk.
authors.forename: Peter A
authors.initials: PA
authors.lastname: Brennan
authors.affiliation: ICBSE, The Royal College of Surgeons of England, London, United Kingdom.
authors.forename: Duncan S
authors.initials: DS
authors.lastname: Scrimgeour
authors.affiliation: Maxillofacial Unit, Queen Alexandra Hospital, Portsmouth, United Kingdom.
authors.forename: Sheena
authors.initials: S
authors.lastname: Patel
authors.affiliation: Maxillofacial Unit, Queen Alexandra Hospital, Portsmouth, United Kingdom.
authors.forename: Roshnee
authors.initials: R
authors.lastname: Patel
authors.affiliation: Intercollegiate Surgical Curriculum Project, London, United Kingdom.
authors.forename: Gareth
authors.initials: G
authors.lastname: Griffiths
authors.affiliation: Royal College of Surgeons in Ireland, Dublin, Ireland.
authors.forename: David T
authors.initials: DT
authors.lastname: Croke
authors.affiliation: ICBSE, The Royal College of Surgeons of England, London, United Kingdom.
authors.forename: Lee
authors.initials: L
authors.lastname: Smith
authors.affiliation: Royal College of Surgeons in Ireland, Dublin, Ireland.
authors.forename: Richard
authors.initials: R
authors.lastname: Arnett
mesh_terms: D002983:Clinical Competence; D004503:Education, Medical, Graduate; D004521:Educational Measurement / Q000379:methods*; D013502:General Surgery / Q000193:education*; D006801:Humans; D007494:Ireland; D062409:Lunch; D009013:Morale; D011795:Surveys and Questionnaires; D006113:United Kingdom
keywords: Interpersonal and Communication Skills; Medical Knowledge; OSCE; Practice-Based Learning and Improvement; Professionalism; System-Based Practice; examiner; human factors; morale; postgraduate surgery examination; stress