Background: Given the complexity of competency frameworks, associated skills and abilities, and contexts in which they are to be assessed in competency-based education (CBE), there is an increased reliance on rater judgements when considering trainee performance. This increased dependence on rater-based assessment has led to the emergence of rater cognition as a field of research in health professions education. The topic, however, is often conceptualised and ultimately investigated using many different perspectives and theoretical frameworks. Critically analysing how researchers think about, study and discuss rater cognition or the judgement processes in assessment frameworks may provide meaningful and efficient directions in how the field continues to explore the topic.
Methods: We conducted a critical and integrative review of the literature to explore common conceptualisations and unified terminology associated with rater cognition research. We identified 1045 articles on rater-based assessment in health professions education using Scorpus, Medline and ERIC and 78 articles were included in our review.
Results: We propose a three-phase framework of observation, processing and integration. We situate nine specific mechanisms and sub-mechanisms described across the literature within these phases: (i) generating automatic impressions about the person; (ii) formulating high-level inferences; (iii) focusing on different dimensions of competencies; (iv) categorising through well-developed schemata based on (a) personal concept of competence, (b) comparison with various exemplars and (c) task and context specificity; (v) weighting and synthesising information differently, (vi) producing narrative judgements; and (vii) translating narrative judgements into scales.
Conclusion: Our review has allowed us to identify common underlying conceptualisations of observed rater mechanisms and subsequently propose a comprehensive, although complex, framework for the dynamic and contextual nature of the rating process. This framework could help bridge the gap between researchers adopting different perspectives when studying rater cognition and enable the interpretation of contradictory findings of raters' performance by determining which mechanism is enabled or disabled in any given context.
© 2016 John Wiley & Sons Ltd.