End-of-Rotation Objective Structured Clinical Examination: Proposal to Reduce Grading Bias in the Family Medicine Core Clerkship

Problem Statement: In medical education, learner assessment drives learning and documents competency. A drawback of the traditional clinical performance assessment by a preceptor, however, is a potential halo effect. This effect is an unearned positive bias toward a student the supervisor likes, or conversely, a negative implicit bias about the student’s race, gender, or other aspects of identity. These biases, in either direction, can lead to unfair grading. A preceptor’s bias can be particularly problematic in a family medicine clerkship in which a student may be evaluated and graded by a single preceptor. Background: An end-of-clerkship objective structured clinical examination (OSCE) is a more objective evaluation with a standard cadre of assessors and grading rubrics. This approach can complement a single assessor and may mitigate biases that stem from individual relationships. Application: We describe the mechanics of end-of-clerkship OSCEs at 4 medical schools and the reasons behind those pedagogic choices as approaches to more objective assessment of student clinical performance in the family medicine clerkship. A medical school’s pursuit of bias reduction and more equitable assessments related to race, gender, and other identities of medical students requires considerable effort. OSCEs, although not perfectly objective, represent an important step that may decrease bias in clinical assessment.