title: Does a web-based feedback training program result in improved reliability in clinicians' ratings of the Global Assessment of Functioning (GAF) Scale?
abstract: The Global Assessment of Functioning (GAF) Scale is used in routine clinical practice and research to estimate symptom and functional severity and longitudinal change. Concerns about poor interrater reliability have been raised, and the present study evaluated the effect of a Web-based GAF training program designed to improve interrater reliability in routine clinical practice. Clinicians rated up to 20 vignettes online, and received deviation scores as immediate feedback (i.e., own scores compared with expert raters) after each rating. Growth curves of absolute SD scores across the vignettes were modeled. A linear mixed effects model, using the clinician's deviation scores from expert raters as the dependent variable, indicated an improvement in reliability during training. Moderation by content of scale (symptoms; functioning), scale range (average; extreme), previous experience with GAF rating, profession, and postgraduate training were assessed. Training reduced deviation scores for inexperienced GAF raters, for individuals in clinical professions other than nursing and medicine, and for individuals with no postgraduate specialization. In addition, training was most beneficial for cases with average severity of symptoms compared with cases with extreme severity. The results support the use of Web-based training with feedback routines as a means to improve the reliability of GAF ratings performed by clinicians in mental health practice. These results especially pertain to clinicians in mental health practice who do not have a masters or doctoral degree.
authors: Department of Psychology, Norwegian University of Science and Technology.
authors: Jakob
authors: J
authors: Støre-Valen
authors: Department of Psychology, Norwegian University of Science and Technology.
authors: Truls
authors: T
authors: Ryum
authors: Department of Personality Psychiatry, Division of Mental Health and Addiction, Oslo University Hospital.
authors: Geir A F
authors: GA
authors: Pedersen
authors: Oslo University Hospital, Biostatistics and Epidemiology Unit.
authors: Are H
authors: AH
authors: Pripp
authors: Victoria University of Wellington, School of Psychology.
authors: Paul E
authors: PE
authors: Jose
authors: Department of Clinical Medicine, University of Oslo.
authors: Sigmund
authors: S
authors: Karterud
mesh_terms: D002983:Clinical Competence; D004506:Education, Nursing; D005260:Female; D000068156:Formative Feedback; D006801:Humans; D020407:Internet; D016014:Linear Models; D008297:Male; D015588:Observer Variation; D011569:Psychiatric Status Rating Scales; D011570:Psychiatry / Q000193:education*; D011584:Psychology / Q000193:education*; D015203:Reproducibility of Results