Can children acting as simulated patients contribute to scoring of student performance in an OSCE?

Background: The voice of the child is increasingly recognized as important, as summed up in the Department of Health report “No decision about me, without me”. In medical education, however, the child’s voice is little heard: often in a pediatric OSCE, the examiner assigns a mark for the child. Aim: To explore whether children can contribute meaningfully to summative scoring of student performance. Methods: We studied this in two phases: first we compared child scores (CSs) to examiner predictions of the child scores (EPCS), and other simulated patient (SP) scores within a single exam. Then we looked at CS over a further 4 exams. Results: The Pearson correlation between CS and EPCS was 0.40 (p < 0.001), therefore EPCS accounted for 16% of variation in CS. Across 4 exams, the mean CS was higher than the mean adult SP score: exploratory factor analysis indicated that both may be measuring the same characteristic. Cronbach’s alpha (0.66 to 0.76) did not significantly increase when SP scores (including CS) were removed. Conclusions: Although there was some correlation between CS and EPCS, pediatricians could not accurately predict CS. We conclude that the child’s voice can and should be heard within the OSCE marking process.