title: Real-time inter-rater reliability of the Council of Emergency Medicine residency directors standardized direct observation assessment tool.
abstract: OBJECTIVE
  Developed by the Council of Emergency Medicine Residency Directors (CORD), the standardized direct observation assessment tool (SDOT) is an evaluation instrument used to assess residents' clinical skills in the emergency department (ED). In a previous study examining the inter-rater agreement of the tool, faculty scored simulated resident-patient encounters. The objective of the present study was to evaluate the inter-rater agreement of the SDOT in real-time evaluations of residents in the ED.
  
  
  METHODS
  This was a multi-center, prospective, observational study in which faculty raters were paired to simultaneously observe and independently evaluate a resident's clinical performance using the SDOT. Data collected from eight emergency medicine (EM) residency programs produced 99 unique resident-patient encounters and reported on 26 individual behaviors related to specific core competencies, global evaluation scores for each core competency, and an overall clinical competency score. Inter-rater agreement was assessed using percentage agreement analyses with three constructs: exact agreement, liberal agreement, and binary (pass/fail) agreement.
  
  
  RESULTS
  Inter-rater agreement between faculty raters varied according to category of measure used. Exact agreement ranged from poor to good, depending on the measure: the overall competency score (good), the competency score for each of the six core competencies (poor to good), and the individual item scores (fair to very good). Liberal agreement and binary agreement were excellent for the overall competency score and the competency score for each of the six core competencies and very good to excellent for the individual item scores.
  
  
  CONCLUSIONS
  The SDOT demonstrated excellent inter-rater agreement when analyzed with liberal agreement and when dichotomized as a pass/fail measure and fair to good agreement for most measures with exact agreement. The SDOT can be useful and reliable when evaluating residents' clinical skills in the ED, particularly as it relates to marginal performance.
authors.affiliation: Department of Emergency Medicine, North Shore University Hospital, Manhasset, NY, USA. jlamanti@nshs.edu
authors.forename: Joseph
authors.initials: J
authors.lastname: LaMantia
authors.forename: Bryan
authors.initials: B
authors.lastname: Kane
authors.forename: Lalena
authors.initials: L
authors.lastname: Yarris
authors.forename: Anthony
authors.initials: A
authors.lastname: Tadros
authors.forename: Mary Frances
authors.initials: MF
authors.lastname: Ward
authors.forename: Martin
authors.initials: M
authors.lastname: Lesser
authors.forename: Philip
authors.initials: P
authors.lastname: Shayne
mesh_terms: D002983:Clinical Competence; D006801:Humans; D007396:Internship and Residency; D011446:Prospective Studies; D015203:Reproducibility of Results