title: Assessing the assessment in emergency care training.
abstract: OBJECTIVE
  Each year over 1.5 million health care professionals attend emergency care courses. Despite high stakes for patients and extensive resources involved, little evidence exists on the quality of assessment. The aim of this study was to evaluate the validity and reliability of commonly used formats in assessing emergency care skills.
  
  
  METHODS
  Residents were assessed at the end of a 2-week emergency course; a subgroup was videotaped. Psychometric analyses were conducted to assess the validity and inter-rater reliability of the assessment instrument, which included a checklist, a 9-item competency scale and a global performance scale.
  
  
  RESULTS
  A group of 144 residents and 12 raters participated in the study; 22 residents were videotaped and re-assessed by 8 raters. The checklists showed limited validity and poor inter-rater reliability for the dimensions "correct" and "timely" (ICC = .30 and.39 resp.). The competency scale had good construct validity, consisting of a clinical and a communication subscale. The internal consistency of the (sub)scales was high (α = .93/.91/.86). The inter-rater reliability was moderate for the clinical competency subscale (.49) and the global performance scale (.50), but poor for the communication subscale (.27). A generalizability study showed that for a reliable assessment 5-13 raters are needed when using checklists, and four when using the clinical competency scale or the global performance scale.
  
  
  CONCLUSIONS
  This study shows poor validity and reliability for assessing emergency skills with checklists but good validity and moderate reliability with clinical competency or global performance scales. Involving more raters can improve the reliability substantially. Recommendations are made to improve this high stakes skill assessment.
authors.affiliation: Erasmus University Medical Center Rotterdam, Rotterdam, the Netherlands.
authors.forename: Mary E W
authors.initials: ME
authors.lastname: Dankbaar
authors.affiliation: Erasmus University Medical Center Rotterdam, Rotterdam, the Netherlands.
authors.forename: Karen M
authors.initials: KM
authors.lastname: Stegers-Jager
authors.affiliation: Training institution for family practice SBOH, Utrecht, the Netherlands.
authors.forename: Frank
authors.initials: F
authors.lastname: Baarveld
authors.affiliation: Maastricht University School of Health Professions Education, Maastricht, the Netherlands.
authors.forename: Jeroen J G van
authors.initials: JJ
authors.lastname: Merrienboer
authors.affiliation: McMaster University, Hamilton, Canada.
authors.forename: Geoff R
authors.initials: GR
authors.lastname: Norman
authors.affiliation: Training institution for family practice SBOH, Utrecht, the Netherlands.
authors.forename: Frans L
authors.initials: FL
authors.lastname: Rutten
authors.affiliation: Erasmus University Medical Center Rotterdam, Rotterdam, the Netherlands.
authors.forename: Jan L C M
authors.initials: JL
authors.lastname: van Saase
authors.affiliation: Erasmus University Medical Center Rotterdam, Rotterdam, the Netherlands.
authors.forename: Stephanie C E
authors.initials: SC
authors.lastname: Schuit
mesh_terms: D004502:Education, Medical, Continuing; D004521:Educational Measurement / Q000379:methods* / Q000592:standards; D004632:Emergency Medical Services; D006801:Humans; D011795:Surveys and Questionnaires / Q000592:standards*