Towards accountability-centred practices: governance in OSCEs subordinating patient and practitioner clinical experience

New public management ideals and standards have become increasingly adhered to in health professions education; this is particularly apparent in high-stakes assessment, as a gateway to practice. Using an Institutional Ethnographic approach, we looked at the work involved in running high-stakes Objective Structured Clinical Exams (OSCEs) throughout an academic year including use of observations, interviews and textual analysis. In our results, we describe three types of 'work'-standardising work, defensibility work and accountability work-summarising these in the discussion as an Accountability Circuit, which shows the organising role of texts on people's work processes. We show how this form of governance mandates a shift towards accountability-centred practices, away from practices which are person-centred; this lens on accountability-centring during high-stakes assessments invites critique of the often-unquestioned emphasis of new public management in health professions education.

Automated summary

New public management ideals and standards are increasingly followed in health professions education, particularly in high-stakes assessment for practice. This study used an Institutional Ethnographic approach to examine the work involved in running high-stakes Objective Structured Clinical Exams (OSCEs). The results reveal three types of work - standardising work, defensibility work, and accountability work - and highlight the shift towards accountability-centred practices.