'We're getting there': Registrar and examiner perspectives on structured oral examinations in emergency medicine.

Abstract

Background: Structured oral examinations (SOEs) are essential for assessing clinical competence in postgraduate emergency medicine qualifications. The rapid shift to web-based SOEs during the coronavirus disease 2019 pandemic and their continued use warrants an exploration of their effectiveness to identify areas for improvement in high-stakes assessments.

Methods: A qualitative, exploratory approach situated within an interpretivist paradigm was used to explore the perspectives of registrars and examiners who had participated in a recent web-based Fellowship of the College of Emergency Medicine Part II examination in South Africa. Six registrars and seven examiners participated in semi-structured interviews. Reflexive thematic analysis, guided by Braun and Clarke's approach, was used to identify key themes from the data.

Results: Participants recognised the value of SOEs in assessment but also highlighted areas for improvement. Concerns included misalignment between exam content and clinical reasoning, anxiety because of the high-stakes nature of the assessment and familiarity with examiners and challenges faced by non-native English speakers. Examiners recommended targeted training in question design and bias mitigation.

Conclusion: Enhancing SOEs through better examiner training and bias mitigation will strengthen their effectiveness. Integrating workplace-based assessment (WBAs) will reduce reliance on SOEs, promoting a more comprehensive approach to assessment in emergency medicine.

Contribution: This study offers practical recommendations for improving examiner training, design and fairness in SOEs. Integrating WBAs with SOEs supports continuous, real-world assessment of competence. Bias-awareness training enhances equity, enabling institutions to design fairer, inclusive assessments.