The undergraduate external examination process and the perceptions of examiners at the physiotherapy departments in South Africa

Background: Variations in external examination processes across South African universities may challenge the validity of physiotherapy assessments. Our study explores external examiners' understanding of moderation and academic standards. Objectives: This study aimed to describe the examination processes and external examiners' perceptions of academic standards in South African physiotherapy programmes. Method: A descriptive cross-sectional survey using a self-administered questionnaire sent to all eight universities that offer a physiotherapy degree in South Africa. The total population size was 103. Results: Practices include appointing the same external examiner for up to 2 years (n = 4), using the same examiner for reassessments (n = 3), and assigning examiners across all modules regardless of expertise (n = 2). Five institutions allocate clinical blocks specifically, and four expose students to all clinical areas. External examiners assess all third- and fourth-year students at five institutions and receive procedural orientation via written guidelines (n = 5). Feedback is typically shared orally (n = 5) or in a university-formatted written report (n = 3). A 10% mark difference is acceptable at two institutions; others lack clear criteria. Internal and external marks carry equal weight, and two universities apply sub minima for clinical safety and effectiveness. Moderation samples span high to low scoring scripts (n = 4). Contingency plans for examiner cancellations are in place at all institutions. Indicators of good performance include evidence-based practice (88%), alignment with departmental outcomes (71%), and meeting examiners' assessment expectations (50%). Conclusion: Clarification of the external examiner's role is needed in the absence of formal guidelines from governing bodies. Clinical implications: Findings can guide consistent competency standards and also support the Health Professions Council in evaluating physiotherapy training institutions.