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Effect of Rater Training on Reliability and Accuracy of Mini-CEX Scores: A Randomized, Controlled Trial

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Abstract

Background

Mini-CEX scores assess resident competence. Rater training might improve mini-CEX score interrater reliability, but evidence is lacking.

Objective

Evaluate a rater training workshop using interrater reliability and accuracy.

Design

Randomized trial (immediate versus delayed workshop) and single-group pre/post study (randomized groups combined).

Setting

Academic medical center.

Participants

Fifty-two internal medicine clinic preceptors (31 randomized and 21 additional workshop attendees).

Intervention

The workshop included rater error training, performance dimension training, behavioral observation training, and frame of reference training using lecture, video, and facilitated discussion. Delayed group received no intervention until after posttest.

Measurements

Mini-CEX ratings at baseline (just before workshop for workshop group), and four weeks later using videotaped resident–patient encounters; mini-CEX ratings of live resident–patient encounters one year preceding and one year following the workshop; rater confidence using mini-CEX.

Results

Among 31 randomized participants, interrater reliabilities in the delayed group (baseline intraclass correlation coefficient [ICC] 0.43, follow-up 0.53) and workshop group (baseline 0.40, follow-up 0.43) were not significantly different (p = 0.19). Mean ratings were similar at baseline (delayed 4.9 [95% confidence interval 4.6–5.2], workshop 4.8 [4.5–5.1]) and follow-up (delayed 5.4 [5.0–5.7], workshop 5.3 [5.0–5.6]; p = 0.88 for interaction). For the entire cohort, rater confidence (1 = not confident, 6 = very confident) improved from mean (SD) 3.8 (1.4) to 4.4 (1.0), p = 0.018. Interrater reliability for ratings of live encounters (entire cohort) was higher after the workshop (ICC 0.34) than before (ICC 0.18) but the standard error of measurement was similar for both periods.

Conclusions

Rater training did not improve interrater reliability or accuracy of mini-CEX scores.

Clinical trials registration

clinicaltrials.gov identifier NCT00667940

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Acknowledgments

We thank E.S. Holmboe for use of scripted cases, G.R. Norman for advice on psychometric analyses, and Mayo Internal Medicine faculty for their participation in this study. Funding was provided by internal sources (the Mayo Education Innovation Program). Study sponsors had no role in the design and conduct of the study; collection, management, analysis, and interpretation of the data; or preparation, review, or approval of the manuscript. Dr. Cook had full access to all the data in the study and takes responsibility for the integrity of the data and the accuracy of the data analysis.

Conflict of Interest

None disclosed.

Author information

Authors and Affiliations

  1. Office of Education Research, College of Medicine, Mayo Clinic, 200 First Street SW, Rochester, MN, 55905, USA

    David A. Cook MD, MHPE & Thomas J. Beckman MD

  2. Division of General Internal Medicine, College of Medicine, Mayo Clinic, 200 First Street SW, Rochester, MN, 55905, USA

    David A. Cook MD, MHPE & Thomas J. Beckman MD

  3. Division of Primary Care Internal Medicine, College of Medicine, Mayo Clinic, 200 First Street SW, Rochester, MN, 55905, USA

    Denise M. Dupras MD, PhD & Kris G. Thomas MD

  4. Division of Biostatistics, College of Medicine, Mayo Clinic, 200 First Street SW, Rochester, MN, 55905, USA

    V. Shane Pankratz PhD

Authors
  1. David A. Cook MD, MHPE
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  2. Denise M. Dupras MD, PhD
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  3. Thomas J. Beckman MD
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  4. Kris G. Thomas MD
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  5. V. Shane Pankratz PhD
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Corresponding author

Correspondence to David A. Cook MD, MHPE.

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Appendix

Cook et al, CEX Rater Training (DOC 129kb)

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Cook, D.A., Dupras, D.M., Beckman, T.J. et al. Effect of Rater Training on Reliability and Accuracy of Mini-CEX Scores: A Randomized, Controlled Trial. J GEN INTERN MED 24, 74–79 (2009). https://doi.org/10.1007/s11606-008-0842-3

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  • DOI: https://doi.org/10.1007/s11606-008-0842-3

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