The influence of candidates' physical attributes on patient ratings in simulated assessments of clinical practice

C A Brown; K Badger; M D Reid; R Westacott; M Gurnell; M W R Reed; G Chamberlain; E Hatfield; A Sharif; A H Sam

doi:10.1080/0142159X.2022.2093177

The influence of candidates' physical attributes on patient ratings in simulated assessments of clinical practice

Med Teach. 2022 Nov;44(11):1277-1282. doi: 10.1080/0142159X.2022.2093177. Epub 2022 Jul 12.

Authors

C A Brown¹, K Badger², M D Reid², R Westacott³, M Gurnell⁴, M W R Reed⁵, G Chamberlain², E Hatfield², A Sharif², A H Sam²

Affiliations

¹ Division of Health Sciences, Warwick Medical School, Coventry, UK.
² Imperial College School of Medicine, Imperial College London, London, UK.
³ Birmingham Medical School, University of Birmingham, Birmingham, UK.
⁴ Wellcome-MRC Institute of Metabolic Science, University of Cambridge and NIHR Cambridge Biomedical Research Centre, Cambridge University Hospitals, Cambridge, UK.
⁵ Brighton and Sussex Medical School, University of Sussex, Brighton, UK.

Abstract

Background: We have previously shown that clinical examiners' scoring is not negatively impacted when a candidate has a tattoo, unnatural hair colour, or a regional accent. We investigated whether these physical attributes in exam candidates impact patient scoring.

Methods: Simulated/real patients were randomly assigned to watch five videos of simulated candidate performances of a cranial nerve examination: clear fail, borderline, good, 'clear pass' without an attribute, and 'clear pass' with one of the attributes (tattoo, purple hair, accent). Participants scored domains of communication and professionalism. We compared scores for the clear pass candidates with and without attributes.

Results: One hundred and eighty three patients participated. The total scores for the candidates with tattoos and purple hair were higher than the candidate with no physical attribute (p < 0.001). For the candidate with a Liverpool English accent no difference was identified (p = 0.120).

Conclusions: The presence of certain physical attributes (tattoos or purple hair) was associated with higher scores given by patients to candidates in a simulated physical examination station.

Keywords: Assessment; clinical; medicine.

Publication types

Randomized Controlled Trial

MeSH terms

Clinical Competence*
Communication
Educational Measurement*
Humans
Physical Examination

Grants and funding

MG is supported by the National Institute for Health Research (NIHR) Cambridge Biomedical Research Centre [BRC-1215-20014]. CAB is supported by the NIHR Applied Research Collaboration (ARC) West Midlands. The views expressed are those of the author(s) and not necessarily those of the NHS, the NIHR or the Department of Health and Social Care. The Medical Schools Council funded the recruitment of the simulated candidates, simulated patient and sourcing of the recording equipment for this study.