title: Impact of rating demands on rater-based assessments of clinical competence.
abstract: OBJECTIVE
  Many assessment practices used in primary care rely upon judgements provided by individuals observing trainees or colleagues. Despite there being many reasons to view these observations as cognitively complex, the extent to which fallibility in judgement reflects mental workload has not been examined experimentally. The objective of this study was to evaluate the impact of increasing rating demands on rater-based assessments of clinical competence.
  
  
  METHODS
  Participants were randomly assigned to one of four conditions (in a 2×2 factorial design) and asked to rate three pre-recorded unscripted clinical encounters illustrating three levels of performance (high, medium, low). We looked at the effect on participants of having a larger (seven) or smaller (two) number of dimensions to rate, and/or distracting them with extraneous tasks (attending to patient status and the activity of additional individuals observable on video). Outcome measures included number of dimension-relevant behaviours identified, ability to differentiate between levels of performance, and inter-rater reliability.
  
  
  RESULTS
  Using the two dimensions common to both groups, ANOVA revealed a significant effect of the number of dimensions included in the scale on the number of relevant behaviours identified: participants in the 2D group identified more features than those in the 7D group. Both groups were able to differentiate between levels of performance, but post hoc analyses revealed significance on all pairwise comparisons in the 2D group and not in the 7D group. Inter-rater reliability increased from 0.45 in the 7D group to 0.70 when participants were required to consider only two dimensions. By contrast, the distractions had little effect.
  
  
  CONCLUSIONS
  The results of this study provide preliminary evidence that requiring raters to consider a greater number of dimensions can decrease (a) the number of dimension-relevant behaviours identified, (b) the capacity to differentiate between levels of performance, and (c) inter-rater reliability.
authors.affiliation: McMaster University, Program for Education Research and Development, Centennial College, School of Community and Health Studies, PO Box 631 Station A, Toronto, On., Canada M1K 5E9. wtavares@centennialcollege.ca.
authors.forename: Walter
authors.initials: W
authors.lastname: Tavares
authors.affiliation: University of British Columbia, Centre for Health Education Scholarship, Canada.
authors.forename: Kevin W
authors.initials: KW
authors.lastname: Eva
mesh_terms: D002983:Clinical Competence; D004521:Educational Measurement / Q000379:methods*; D006801:Humans; D007600:Judgment; D011320:Primary Health Care; D015203:Reproducibility of Results