The general practice specialist examination – examiners’ perspectives on the status quo and future development: An exploratory qualitative study

Background: The specialist examination has a substantial impact on the quality of healthcare delivery. The aim of this study was to explore examiners’ perspectives on the current examination format, their motivation for serving as examiners, perceived strengths and weaknesses of the existing assessment, suggestions for improvement, and the perceived effects of Competence Centres for Postgraduate Training (CCPTs). Methods: Examiners from across Germany were recruited and interviewed in semi-structured video interviews using a self-developed interview guide. Interviews were transcribed verbatim and analysed using qualitative content analysis. Results: Twelve examiners from six federal states participated. The mean interview duration was 33 minutes (range: 24-57 minutes). Key advantages identified included the one-to-one examination setting, the ability to ensure a minimum standard of specialist competence and the examination's efficiency in terms of time and resources. Oral examinations were perceived as having limited ability to assess the complex clinical competencies required in patient care. Perceived needs for change varied among participants. Suggested improvements included examiner training, the development of shared assessment criteria and the introduction of practical examination components. Longitudinal assessments were also mentioned. Discussion: Examiners recognised limitations of the current examination regarding objectivity, reliability, validity and contextual sensitivity, particularly in relation to the complexity of general practice. Nevertheless, they considered the assessment of a minimum standard of specialist competence to be feasible. The findings reveal a tension between practical feasibility and educational assessment standards. Potential areas for improvement include examiner training, regular exchange among examiners, shared assessment frameworks, a clearer definition of examination objectives and the implementation of longitudinal assessment approaches (e.g. portfolio-based assessment with regular interim assessments). Conclusions: The specialist examination demonstrates considerable potential for further development. Shared assessment frameworks, as developed during examiner training, could provide greater structure to the examination process and may be implemented with relative ease.