How do examiners decide?: a qualitative study of the process of decision making in the oral examination component of the MRCGP examination

Objective To determine how examiners make decisions about candidates in the oral examination for membership in the Royal College of General Practitioners. Design Qualitative research using interpersonal process recall interviews with oral examiners immediately following examination of an Medical Research Council General Practitioner (MRCGP) candidate. Setting Summer 1999 sessions of the MRCGP examination in Edinburgh and London. Participants Twenty-six examiners in a convenience sample from the panel of Royal College of General Practitioners (RCGP) oral examiners. Results Analysis of the transcripts revealed a three-stage process of decision-making consisting of a first impression, followed by a provisional grade and a final grade decision. The examiners used stem questions, exploratory questions and confirming questions during this process. Examiners produced lists of the attributes of successful and unsuccessful candidates, which resembled the grading guidelines provided by the examination committee. Some of the candidates' attributes which influenced the examiners' grading decisions related to personal qualities rather than knowledge or behaviours acquired in vocational training. When examiners were presented with the explanatory model arising from the analysis of the transcripts, they confirmed the validity of the observations. Conclusions Decision-making by examiners during oral examinations is a complex process involving initial impressions, hypothesis generation and hypothesis testing. Candidates' knowledge, attitudes and performance influence the final outcome of the examination. Interpersonal process recall is a useful tool for exploring professional communication.