title: Developing Validity Evidence for the Written Pediatric History and Physical Exam Evaluation Rubric.
abstract: The written history and physical examination (H&P) is an underutilized source of medical trainee assessment. The authors describe development and validity evidence for the Pediatric History and Physical Exam Evaluation (P-HAPEE) rubric: a novel tool for evaluating written H&Ps.
  
  
  
  Using an iterative process, the authors drafted, revised, and implemented the 10-item rubric at 3 academic institutions in 2014. Eighteen attending physicians and 5 senior residents each scored 10 third-year medical student H&Ps. Inter-rater reliability (IRR) was determined using intraclass correlation coefficients. Cronbach α was used to report consistency and Spearman rank-order correlations to determine relationships between rubric items. Raters provided a global assessment, recorded time to review and score each H&P, and completed a rubric utility survey.
  
  
  
  Overall intraclass correlation was 0.85, indicating adequate IRR. Global assessment IRR was 0.89. IRR for low- and high-quality H&Ps was significantly greater than for medium-quality ones but did not differ on the basis of rater category (attending physician vs. senior resident), note format (electronic health record vs nonelectronic), or student diagnostic accuracy. Cronbach α was 0.93. The highest correlation between an individual item and total score was for assessments was 0.84; the highest interitem correlation was between assessment and differential diagnosis (0.78). Mean time to review and score an H&P was 16.3 minutes; residents took significantly longer than attending physicians. All raters described rubric utility as "good" or "very good" and endorsed continued use.
  
  
  
  The P-HAPEE rubric offers a novel, practical, reliable, and valid method for supervising physicians to assess pediatric written H&Ps.
authors: Division of General Academic Pediatrics, Saint Louis University School of Medicine, St Louis, Mo. Electronic address: making@slu.edu.
authors: Marta A
authors: MA
authors: King
authors: Department of Pediatrics, Oregon Health & Science University, Portland, OR.
authors: Carrie A
authors: CA
authors: Phillipi
authors: Center for Outcomes Research, Saint Louis University, St Louis, Mo.
authors: Paula M
authors: PM
authors: Buchanan
authors: Department of Pediatrics, University of Maryland School of Medicine, Bethesda, MD.
authors: Linda O
authors: LO
authors: Lewin
mesh_terms: D002983:Clinical Competence; D004282:Documentation / Q000592:standards*; D004504:Education, Medical, Undergraduate; D005163:Factor Analysis, Statistical; D006801:Humans; D008487:Medical History Taking; D010372:Pediatrics / Q000193:education*; D010808:Physical Examination; D015203:Reproducibility of Results
keywords: assessment; clinical documentation; diagnostic reasoning; history; medical student; physical examination; undergraduate medical education