Inayah A'man Talal, Anwer Lucman A, Shareef Mohammad Abrar, Nurhussen Akram, Alkabbani Haifa Mazen, Alzahrani Alhanouf A, Obad Adam Subait, Zafar Muhammad, Afsar Nasir Ali
College of Medicine, Alfaisal University, Riyadh, Saudi Arabia.
Mayo Clinic, Rochester, USA.
BMJ Open. 2017 May 9;7(5):e012289. doi: 10.1136/bmjopen-2016-012289.
The qualitative subjective assessment has been exercised either by self-reflection (self-assessment (SA)) or by an observer (peer assessment (PA)) and is considered to play an important role in students' development. The objectivity of PA and SA by students as well as those by faculty examiners has remained debated. This matters most when it comes to a high-stakes examination. We explored the degree of objectivity in PA, SA, as well as the global rating by examiners being Examiners' Subjective Assessment (ESA) compared with Objective Structured Clinical Examinations (OSCE).
Prospective cohort study.
Undergraduate medical students at Alfaisal University, Riyadh.
All second-year medical students (n=164) of genders, taking a course to learn clinical history taking and general physical examination.
A Likert scale questionnaire was distributed among the participants during selected clinical skills sessions. Each student was evaluated randomly by peers (PA) as well as by himself/herself (SA). Two OSCEs were conducted where students were assessed by an examiner objectively as well as subjectively (ESA) for a global rating of confidence and well-preparedness. OSCE-1 had fewer topics and stations, whereas OSCE-2 was terminal and full scale.
OSCE-1 (B=0.10) and ESA (B=8.16) predicted OSCE-2 scores. 'No nervousness' in PA (r=0.185, p=0.018) and 'confidence' in SA (r=0.207, p=0.008) correlated with 'confidence' in ESA. In 'well-preparedness', SA correlated with ESA (r=0.234, p=0.003).
OSCE-1 and ESA predicted students' performance in the OSCE-2, a high-stakes evaluation, indicating practical 'objectivity' in ESA, whereas SA and PA had minimal predictive role. Certain components of SA and PA correlated with ESA, suggesting partial objectivity given the limited objectiveness of ESA. Such difference in 'qualitative' objectivity probably reflects experience. Thus, subjective assessment can be used with some degree of objectivity for continuous assessment.
定性主观评估可通过自我反思（自我评估（SA））或由观察者进行（同伴评估（PA）），并被认为在学生发展中发挥重要作用。学生进行的同伴评估和自我评估以及教师考官进行的评估的客观性一直存在争议。在高风险考试中，这一点最为重要。我们探讨了同伴评估、自我评估以及考官的整体评分（考官主观评估（ESA））与客观结构化临床考试（OSCE）相比的客观程度。
前瞻性队列研究。
利雅得阿费萨尔大学的本科医学生。
所有二年级医学生（n = 164），无论性别，正在学习临床病史采集和一般体格检查课程。
在选定的临床技能课程期间，向参与者发放了一份李克特量表问卷。每个学生由同伴（同伴评估）以及他/她自己（自我评估）进行随机评估。进行了两次客观结构化临床考试，考官对学生进行客观和主观（考官主观评估）评估，以获得信心和准备充分程度的整体评分。客观结构化临床考试 - 1的主题和站点较少，而客观结构化临床考试 - 2是期末考试且规模完整。
客观结构化临床考试 - 1（B = 0.10）和考官主观评估（B = 8.16）可预测客观结构化临床考试 - 2的分数。同伴评估中的“不紧张”（r = 0.185，p = 0.018）和自我评估中的“自信”（r = 0.207，p = 0.008）与考官主观评估中的“自信”相关。在“准备充分程度”方面，自我评估与考官主观评估相关（r = 0.234，p = 0.003）。
客观结构化临床考试 - 1和考官主观评估可预测学生在客观结构化临床考试 - 2（一项高风险评估）中的表现，表明考官主观评估具有实际的“客观性”，而自我评估和同伴评估的预测作用最小。自我评估和同伴评估的某些组成部分与考官主观评估相关，鉴于考官主观评估的客观性有限，这表明存在部分客观性。这种“定性”客观性的差异可能反映了经验。因此，主观评估可在一定程度上客观地用于持续评估。
