title: The Hidden Value of Narrative Comments for Assessment: A Quantitative Reliability Analysis of Qualitative Data.
abstract: In-training evaluation reports (ITERs) are ubiquitous in internal medicine (IM) residency. Written comments can provide a rich data source, yet are often overlooked. This study determined the reliability of using variable amounts of commentary to discriminate between residents.
  
  
  
  ITER comments from two cohorts of PGY-1s in IM at the University of Toronto (graduating 2010 and 2011; n = 46-48) were put into sets containing 15 to 16 residents. Parallel sets were created: one with comments from the full year and one with comments from only the first three assessments. Each set was rank-ordered by four internists external to the program between April 2014 and May 2015 (n = 24). Generalizability analyses and a decision study were performed.
  
  
  
  For the full year of comments, reliability coefficients averaged across four rankers were G = 0.85 and G = 0.91 for the two cohorts. For a single ranker, G = 0.60 and G = 0.73. Using only the first three assessments, reliabilities remained high at G = 0.66 and G = 0.60 for a single ranker. In a decision study, if two internists ranked the first three assessments, reliability would be G = 0.80 and G = 0.75 for the two cohorts.
  
  
  
  Using written comments to discriminate between residents can be extremely reliable even after only several reports are collected. This suggests a way to identify residents early on who may require attention. These findings contribute evidence to support the validity argument for using qualitative data for assessment.
authors.affiliation: S. Ginsburg is professor, Department of Medicine, and scientist, Wilson Centre for Research in Education, Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada. C.P.M. van der Vleuten is professor of education, Department of Educational Development and Research, Faculty of Health, Medicine and Life Sciences, Maastricht University, Maastricht, the Netherlands. K.W. Eva is associate director and senior scientist, Centre for Health Education Scholarship, and professor and director of educational research and scholarship, Faculty of Medicine, University of British Columbia, Vancouver, British Columbia, Canada.
authors.forename: Shiphra
authors.initials: S
authors.lastname: Ginsburg
authors.forename: Cees P M
authors.initials: CPM
authors.lastname: van der Vleuten
authors.forename: Kevin W
authors.initials: KW
authors.lastname: Eva
mesh_terms: D002983:Clinical Competence; D004521:Educational Measurement; D006801:Humans; D007388:Internal Medicine / Q000193:education*; D007396:Internship and Residency; D033262:Narration; D015203:Reproducibility of Results