Quality Action Assurance: Multimodal Verification of Examiner Claims in VR OSCEs

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arXiv:2607.19063v3 Announce Type: replace Abstract: Objective Structured Clinical Examinations (OSCEs) are the gold standard for assessing clinical competence, yet scoring remains vulnerable to examiner subjectivity, fatigue, and cognitive bias. Standard examiner validation via inter-rater statistics lacks explanatory power regarding the source of errors, as it neither analyzes examiner reasoning nor verifies examiner claims against actual events. Thus, we introduce Quality Action Assurance (QAA), a multimodal framework that verifies examiner claims in Virtual Reality (VR) pediatric OSCEs by comparing actions claimed by examiners against a reference record of events constructed from video, VR logs, and actor annotations. QAA combines a constrained temporal action alignment model, which performs action localization and actor source attribution, with a large language model that extracts examiner claims and checks them against the record. Across a 5-fold cross-validation, QAA achieves 99.2\% $\pm$ 0.7\% Actor F1 and 93.4\% $\pm$ 1.9\% W@16 for temporal alignment. Overall, QAA detects examiner errors with 69.9\% precision and 76.7\% recall; in retrospective evaluation, correcting the detected errors raises the share of factually correct transcripts from 39.2\% to 79.2\%, supporting fairer OSCE quality assessment.

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