The use of child actors to simulate paediatric patients in the MRCGP Clinical Skills Assessment (CSA): developing an effective model.

Role-player consistency between candidates is a crucial component of the reliability of the Objective Structured Clinical Examination (OSCE) format used for clinical skills assessment (CSA). It is particularly important in a high-stakes licensing assessment such as the Membership of the Royal College of General Practitioners' (MRCGP's) CSA. The current organisation of the CSA examination poses particular challenges for child actors. The stringent licensing process for child actors limits the working hours of children aged under 13 years considerably, making it impossible for them to perform in both the morning and afternoon circuits on examination days. Children aged nine years or younger are not able to complete even a single morning or afternoon circuit. Younger children also appear disproportionately to become fatigued and less consistent with time. All children require significant support from their adult role-player parent. Careful piloting has allowed us to develop a solution which requires the use of natural pairs of adult and child role players in two teams for the morning and afternoon circuits. A new process for training and calibrating the children the day before their performance in addition to calibration on the day appears to improve the consistency of their performance. The aim of this paper is to describe the action research-based cycle through which we developed our training procedures for child actors for the MRCGP CSA. We believe, given the challenges we have outlined, our experience will be of interest to all educators involved in the CSA process.