fig8

Figure 8. Publication bias assessment; funnel plot for assessment of publication bias in skill accuracy studies. Funnel plot examining potential publication bias in the skill assessment accuracy meta-analysis. Effect sizes (logit-transformed proportions) are plotted against their standard errors, with the vertical dashed line representing the pooled estimate. The diagonal dashed lines indicate the expected 95% confidence limits. Studies are distributed relatively symmetrically around the pooled estimate, with larger studies (smaller standard error) clustering near the top and smaller studies showing greater variability. The symmetric distribution suggests minimal publication bias, confirmed by Egger’s test (P > 0.05). All studies fall within the expected confidence limits, indicating no outliers. The slight gap in the lower corners is expected given the high overall accuracy rates limiting the range of possible values.