Abstract
Background: Several forms of bias, including ethnic and gender bias, are thought to impact evaluations on Clinical Performance Assessments (CPAs). Unfairness may influence student learning attitudes if a loss of trust causes a lack of engagement in learning. Understanding the biases occurring in CPAs can lead to well-designed examiner training to ensure equality and fairness. The purpose of this systematic review is to determine the current evidence in the literature for ethnic and/or gender bias by examiners evaluating pre-licensure healthcare students in CPAs using standardized patients (SPs). Methods: Literature was systematically searched in CINAHL, PubMed and Medline from inception to February 2019, and no date range was set. Studies related to the investigation of ethnic and/or gender biases occurring in CPAs using SPs for examining health professions students were selected. A systematic review was conducted to assess the methodological quality and strength of evidence of relevant research and to identify if any potential ethnic and/or gender bias occurred in CPAs. The Guidelines for Critical Review were used to appraise the selected studies. Results: Nine studies published from 2003 to 2017 were retrieved for review. Three studies met all the Guidelines for Critical Review quality criteria, indicating stronger evidence of their outcomes, two of the studies reported ethnic and/or gender bias existing in the CPAs. Overall, four studies found ethnic and/or gender bias in CPAs, but all study results had small effect sizes. Conclusions: No systematic and consistent bias was found across the studies; nonetheless, the possibility of ethnic or gender bias by some examiners cannot be ignored. To minimize potential examiner bias, the investigation of Frame of Reference training, multiple examiners per station, and combination assessments in CPAs is recommended.
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