Reliability of the history and physical assessment (HAPA) form

Medical student assessment on core clerkship rotations is notoriously difficult. Most evaluation is subjective and may include significant bias. This study aims to determine the inter-rater reliability of an objective, standardised history and physical examination write-up assessment (HAPA) form.

The HAPA form was used by two paediatrician evaluators to assess 10 student history and physical examination write-ups (H&Ps). Kappa scores were determined to assess agreement between evaluators for each HAPA form item, for the total HAPA form score and for an additional 'overall assessment' score.

The kappa scores were relatively high, indicating good agreement between evaluators for the major HAPA form sections: 0.59 for data collection; 0.66 for critical reasoning; and 0.36 for communication skills. The kappa score for the total HAPA form score was 0.58, which was higher than the agreement derived from an 'overall assessment' score (0.30) that the evaluators provided for the H&P.

A standardised form for H&P assessment (the HAPA form) provides superior reliability to the 'overall assessment' of H&Ps that is often used in clerkships for evaluation. Criterion-based evaluation of the student write-up can provide reliable evaluation and feedback to students on a clerkship.