High Fidelity Human Simulation in Physical Therapy: Reliability of Lasater Clinical Judgment Rubric

Purpose/Hypothesis : As the use of high fidelity human simulation (HFHS) increases in Physical Therapy (PT) education, the educators are challenged to evaluate students' clinical judgment skills. The Lasater Clinical Judgment Rubric (LCJR), which is based on the Tanner Clinical Judgment Model, was developed in response to an identified need for a standard evaluative language to discuss clinical judgment with students in the simulation setting. The purpose of the current study was to evaluate the reliability of LCJR when used by practicing PT clinicians to measure physical therapy student performance in a simulated clinical setting. Additionally, focus group interviews were used to examine validity of the LCJR for use by clinicians to measure PT student performance in a simulated clinical setting.Number of Subjects : Eight 2nd semester PT students from Fresno State participated in a cardiopulmonary rehabilitation simulation scenario in pairs. The scenario involved a patient with CHF who was admitted 2 days prior to acute care secondary to shortness of breath. The admitting physician left orders for PT to evaluate and treat. 11 clinicians from the Community Regional Medical CenterÕs acute care department and 2 clinicians from the San Joaquin Valley Rehabilitation hospital participated in the study. All the raters had at least 3 years of experience as a Physical Therapist and had each mentored at least one student for an internship.Materials/Methods : Raters were allowed to examine the LCJR and ask questions, but no special training was provided. All raters rated two students using the LCJR on the first of two days, and the same two students a week later. The second rater session was followed immediately by a question and answer session in which raters were asked about the usability and usefulness of the rubric, particularly itÕs ability to effectively distinguish students from one another. Inter-and intra-rater reliability values were calculated. The reliability between and among practicing physical therapy clinicians was measured.Results : Intra-class Correlation Coefficient shows a value of 0.930 with significance at p=0.000. This demonstrates extremely good consistency between any given raters first attempt at rating a student and their second attempt. FleissÕ kappa was calculated to assess the reliability of agreement between multiple raters, when assigning categorical ratings to the students. A good agreement was found (FleissÕ Kappa = 0.64, SE = .15, 95% CI = 0.35 to 0.94). The focus group interviews showed high face validity for the tool but also revealed a need for more training for the clinicians before using LCJR.Conclusions : Thus, LCJR has a high interrator and moderate interrator reliability and high face validity for by clinicians to measure physical therapy student clinical judgment in simulated as well as clinical settingClinical Relevance : This study critically examined the Lasater Clinical Judgement Rubric in an effort to assess its use as a valid and reliable measurement tool, and to identify specific needs for continued testing of the instrument.

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  • Control #: 1727676
  • Type: Poster
  • Event/Year: CSM2014
  • Authors: Harshavardhan Deoghare, Leslie T. Zarrinkhameh
  • Keywords: Simulation|Clinical Judgement|Student Evaluation

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