What influences assessors' internalised standards? C. Poole a, b, * , J. Boland b, 1 a Applied Radiation Therapy Trinity Research Group, School of Medicine, Discipline of Radiation Therapy, Trinity College Dublin, The University of Dublin, Ireland b School of Medicine, National University of Ireland Galway, Galway, Ireland article info Article history: Received 9 July 2015 Received in revised form 13 November 2015 Accepted 21 November 2015 Available online 19 December 2015 Keywords: Clinical assessment Clinical education Reliability of assessment Competence Work based assessment abstract Purpose: The meaning assessors attach to assessment criteria during clinical placement is under- researched. While personal beliefs, values or expectations may influence judgements, there is scant evidence of how this manifests in a clinical attachment setting. This research explored the concept and source of internalised standards and how these may influence judgements. Methods: This study, within the constructivist paradigm, was informed by the principles of grounded theory. Seven radiation therapists, purposefully selected, were interviewed face-to-face using semi- structured interviews. The sample size allowed for the gathering of sufficient data for in-depth the- matic analysis, using the functionality of CAQDAS (NVivo 9). Results: Radiation therapists' judgements when assessing students were influenced by their previous experience. They had different expectations of the appropriate standard for each criterion on students' assessment forms e relating to technical ability, clinical knowledge and attitude. They had their own set of values, or expectations which informed ‘internalised standards’ which influenced their judgements about student performance. Prior experience e as students and as qualified professionals e influenced these decisions. Conclusion: Assessment of students' performance may differ depending on the clinician conducting the assessment. Even where assessors are given the same criteria and training, this does not ensure reli- ability, as judgements are influenced by their internalised standards. This has implications for the design of more appropriate assessor training which recognises and addresses this phenomenon. These results will be of interest to radiation therapists, radiographers, medical educators, allied health professionals and any academic or professional body with responsibility for ensuring that we qualify competent practitioners. © 2015 The College of Radiographers. Published by Elsevier Ltd. All rights reserved. Introduction Clinical placement is a core component of undergraduate edu- cation in all medical/health science programmes. Clinical teachers have a pivotal role in facilitating learning. Effective clinical teaching and assessment, however, is a complex role that combines clinical obligations and teaching management. Some clinical practitioners teach, assess and supervise students, in addition to their clinical duties 1 and thereby become clinical teachers. Driving learning, assessment influences what students actually learn. 2 A well designed assessment can be a robust educational tool where the student can develop and learn by being aware and reflecting on their strength and weakness. 3 Observation of a professional's habitual behaviour at work is regarded as one of the only effective methods of accurately assessing the core traits of performance required to perform competently in the working environment. 4,5 Performance assessment relates to the uppermost domain of Miller's Pyramid (or Prism) of clinical competence. 3,4,6e8 The lower two levels relate to knowledge and application of knowledge. Level 3, coined ‘shows how’ can be assessed in vitro whereas level 4, or ‘does’ involves assessment of performance in the workplace. 6,7,9 In recent years, performance or work based assessment (WBA) is of growing importance for summative purposes within medical and health science education and training. 7,10,11 Therefore educational institutions must implement robust and reliable performance assessment training programmes for assessors. * Corresponding author. Applied Radiation Therapy Trinity Research Group, School of Medicine, Discipline of Radiation Therapy, Trinity College Dublin, The University of Dublin, Centre for Health Sciences, St. James's Hospital, Dublin 8, Ireland. Tel.: þ353 (0) 1 8962973; fax: þ353 (0) 1 8963246. E-mail addresses: poolec@tcd.ie (C. Poole), josephine.boland@nuigalway.ie (J. Boland). 1 Tel.: þ353 (0) 91493857; fax: þ353 (0) 91494519. Contents lists available at ScienceDirect Radiography journal homepage: www.elsevier.com/locate/radi http://dx.doi.org/10.1016/j.radi.2015.11.003 1078-8174/© 2015 The College of Radiographers. Published by Elsevier Ltd. All rights reserved. Radiography 22 (2016) e99ee105