A randomised controlled trial of the influence of Non-native English accents on Examiners’ scores in OSCEs
Abstract BackgroundObjective Structured Clinical Examinations (OSCEs) are important aspects of assessment in medical education. There are anecdotes that students with non-native English accents (NNEA) may be marked negatively due to unconscious bias. It is imperative to minimise the examiners’ bias so that the difference in the scores reflects students’ clinical competence. Research in shows NNEAs can cause stereotyping, often leading to the speaker being negatively judged. However, no medical education study has looked at the influence of NNEAs in assessment.MethodsThis is a randomised, single - blinded controlled trial. Four videos of one mock OSCE station were produced. A professional actor played a medical student. Two near identical scripts were prepared. Two videos showed the actor speaking with an Indian accent and two videos showed the actor speaking without the accent in either script. Forty-two UK OSCE examiners were recruited and randomly assigned to two groups. They watched two videos online, each with either script, with and without the NNEA. Checklist item scores were analysed with descriptive statistics and simple linear regression model. Global scores were analysed with descriptive statistics and logistic ordinal regression model.ResultsThirty-two examiners completed the study. The average scores for the checklist items (41.6 points) did not change when the accent variable was changed. Simple linear regression model showed no statistically significant relationship between the accent and the scores (Regression coefficient = 0.032, p = 0.982). For the global scores received by the videos with the NNEA, there were one less ‘Good’ grade and one more ‘Fail’ grade compared to the ones without the NNEA. Logistical ordinal regression model on global scores showed, examiners were more likely to mark the student more negatively (p < 0.0001) but also more positively (p < 0.0001) when the NNEA was present.ConclusionsExaminers could be biased either positively or negatively towards NNEAs when giving global scores. Further research is required to consider the nature of this bias. More discussion is warranted to consider how the accent should be considered in current medical education assessment.
