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Updated: Jun 5, 2026

The Resident-intruder Paradigm: A Standardized Test for Aggression, Violence and Social Stress
Published on: July 4, 2013
An approach to evaluating competence in assessing and managing violence risk
Dale E McNiel1, Erick K Hung, Robert J Cramer
1Department of Psychiatry, University of California, San Francisco, 401 Parnassus, San Francisco, CA 94143, USA. dalem@lppi.ucsf.edu
Objective:
The authors developed and evaluated a tool for assessing competency in violence risk assessment and management.
Methods:
The Competency Assessment Instrument for Violence Risk (CAI-V) was based on the literature on violence risk assessment, which was complemented by feedback from faculty focus groups. In an objective structured clinical examination, 31 faculty observers used the CAI-V to rate the performance of 31 learners' (26 psychiatry residents and five psychology interns) risk assessments of standardized (simulated) patients. In an interrater reliability study, six faculty members rated video-recorded risk assessments.
Results:
The CAI-V had good internal consistency reliability (α=.93). Senior learners performed better on the CAI-V than junior learners, supporting the instrument's concurrent validity. Interrater reliability was good (intraclass correlation coefficient=.93). Participants reported that the CAI-V provided a helpful structure for feedback and supervision.
Conclusions:
The results supported the potential of this new approach for appraising competency in violence risk assessment and management.
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