title: Effects of questionnaire-based diagnosis and training on inter-rater reliability among practitioners of traditional Chinese medicine.
abstract: OBJECTIVE
  To investigate whether a training process that focused on a questionnaire-based diagnosis in Traditional Chinese Medicine (TCM), and developing diagnostic consensus, would improve the agreement of TCM diagnoses among 10 TCM practitioners evaluating patients with temporomandibular joint disorder (TMJD).
  
  
  METHODS
  Evaluation of a diagnostic training program at the Department of Family and Community Medicine, University of Arizona, Tucson, Arizona, and the Oregon College of Oriental Medicine, Portland, Oregon.
  
  
  METHODS
  Screened participants for a study of TCM for TMJD. PRACTITIONERS: Ten (10) licensed acupuncturists with a minimum of 5 years licensure and education in Chinese herbs.
  
  
  METHODS
  A training session using a questionnaire-based diagnostic form was conducted, followed by waves of diagnostic sessions. Between sessions, practitioners discussed the results of the previous round of participants with a focus on reducing variability in primary diagnosis and severity rating of each diagnosis: 3 waves of 5 patients were assessed by 4 practitioner pairs for a total of 120 diagnoses. At 18 months, practitioners completed a recalibration exercise with a similar format with a total of 32 diagnoses. These diagnoses were then examined with respect to the rate of agreement among the 10 practitioners using inter-rater correlations and kappas.
  
  
  RESULTS
  The inter-rater correlation with respect to the TCM diagnoses among the 10 practitioners increased from 0.112 to 0.618 with training. Statistically significant improvements were found between the baseline and 18 month exercises (p < 0.01).
  
  
  CONCLUSIONS
  Inter-rater reliability of TCM diagnosis may be improved through a training process and a questionnaire-based diagnosis process. The improvements varied by diagnosis, with the greatest congruence among primary and more severe diagnoses. Future TCM studies should consider including calibration training to improve the validity of results.
authors.affiliation: Oregon College of Oriental Medicine, Portland, OR, USA.
authors.forename: Scott
authors.initials: S
authors.lastname: Mist
authors.forename: Cheryl
authors.initials: C
authors.lastname: Ritenbaugh
authors.forename: Mikel
authors.initials: M
authors.lastname: Aickin
mesh_terms: D026881:Acupuncture / Q000193:education; D001130:Arizona; D002983:Clinical Competence; D003162:Competency-Based Education; D003937:Diagnosis, Differential; D006282:Health Personnel / Q000193:education*; D006801:Humans; D007318:Inservice Training; D008516:Medicine, Chinese Traditional / Q000379:methods / Q000592:standards*; D015588:Observer Variation; D009922:Oregon; D010808:Physical Examination / Q000379:methods / Q000592:standards*; D011785:Quality Assurance, Health Care; D015203:Reproducibility of Results; D011795:Surveys and Questionnaires