Making it fair: Learners' and assessors' perspectives of the attributes of fair judgement.

INTRODUCTION: Optimising the use of subjective human judgement in assessment requires understanding what makes judgement fair. Whilst fairness cannot be simplistically defined, the underpinnings of fair judgement within the literature have been previously combined to create a theoretically-constructed conceptual model. However understanding assessors' and learners' perceptions of what is fair human judgement is also necessary. The aim of this study is to explore assessors' and learners' perceptions of fair human judgement, and to compare these to the conceptual model. METHODS: A thematic analysis approach was used. A purposive sample of twelve assessors and eight post-graduate trainees undertook semi-structured interviews using vignettes. Themes were identified using the process of constant comparison. Collection, analysis and coding of the data occurred simultaneously in an iterative manner until saturation was reached. RESULTS: This study supported the literature-derived conceptual model suggesting fairness is a multi-dimensional construct with components at individual, system and environmental levels. At an individual level, contextual, longitudinally-collected evidence, which is supported by narrative, and falls within ill-defined boundaries is essential for fair judgement. Assessor agility and expertise are needed to interpret and interrogate evidence, identify boundaries and provide narrative feedback to allow for improvement. At a system level, factors such as multiple opportunities to demonstrate competence and improvement, multiple assessors to allow for different perspectives to be triangulated, and documentation are needed for fair judgement. These system features can be optimized through procedural fairness. Finally, appropriate learning and working environments which considers patient needs and learners personal circumstances are needed for fair judgments. DISCUSSION: This study builds on the theory-derived conceptual model demonstrating the components of fair judgement can be explicitly articulated whilst embracing the complexity and contextual nature of health-professions assessment. Thus it provides a narrative to support dialogue between learner, assessor and institutions about ensuring fair judgements in assessment.