title: Effect of rater training on reliability and accuracy of mini-CEX scores: a randomized, controlled trial.
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.
  
  
  METHODS
  Randomized trial (immediate versus delayed workshop) and single-group pre/post study (randomized groups combined).
  
  
  METHODS
  Academic medical center.
  
  
  METHODS
  Fifty-two internal medicine clinic preceptors (31 randomized and 21 additional workshop attendees).
  
  
  METHODS
  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.
  
  
  METHODS
  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.
  
  
  BACKGROUND
  clinicaltrials.gov identifier NCT00667940
authors.affiliation: Office of Education Research, College of Medicine, Mayo Clinic, Rochester, MN 55905, USA. cook.david33@mayo.edu
authors.forename: David A
authors.initials: DA
authors.lastname: Cook
authors.forename: Denise M
authors.initials: DM
authors.lastname: Dupras
authors.forename: Thomas J
authors.initials: TJ
authors.lastname: Beckman
authors.forename: Kris G
authors.initials: KG
authors.lastname: Thomas
authors.forename: V Shane
authors.initials: VS
authors.lastname: Pankratz
mesh_terms: D000328:Adult; D002983:Clinical Competence / Q000592:standards*; D004493:Education / Q000379:methods / Q000592:standards; D004521:Educational Measurement / Q000379:methods / Q000592:standards*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007388:Internal Medicine / Q000193:education / Q000592:standards; D007396:Internship and Residency / Q000379:methods / Q000592:standards; D008297:Male; D008875:Middle Aged; D011231:Preceptorship / Q000379:methods / Q000592:standards