LAUSR

I read with interest the article by Wood and Pugh (2019) comparing rating scales and checklists as tools of measuring increasing levels of expertise in an OSCE setting. I commend the authors for challenging the doctrine that rating scales are superior to checklists via this study. As a finalyear medical student at University College London (UCL), I would like to share my thoughts with regards to OSCE assessments over the years. Broadly speaking, adapting the study focusing on Internal Medicine residents to medical students, I agree that the choice of assessment tool should be catered to the objectives of each OSCE station. After all, OSCE stations are varied in content and delivery style to reflect the diverse expectations required of a future physician. However, from the perspective of a medical student, I worry that checklists will cause students to become incentivised towards rote learning without a deeper appreciation for the task assigned. Meanwhile, rating scales inherently lend themselves towards the subjectivity of examiners. Consequently, I suggest a balancing act is required to overcome these barriers. At UCL, role players acting as patients in OSCE stations are given the opportunity to assess students. Although the eventual score remains largely directed by the examiner, it has been shown that having this additional input does attenuate subjectivity (Johnston et al. 2013). Taking this further, the balancing act that I suggest is the combined use of checklists by examiners and rating scales by role players to assess technical and soft skills, respectively. Firstly, checklists ensure a standardised assessment of essential medical skills and may even allow examiners more time to record detailed feedback on the candidate’s performance. Secondly, rating scales allow for a more intuitive assessment of soft skills such as communication and empathy, preventing these important qualities from being a mere tick-box exercise. When used in combination, I am hopeful that the advantages of each assessment tool can be truly maximised while mitigating the drawbacks.