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Assessment of medical student clinical reasoning by "lay" vs physician raters: inter-rater reliability using a
Alexandra J Berger1, Colleen C Gillespie, Linda R Tewksbury
1Department of Surgery, New York University School of Medicine, New York, NY, USA.
Background:
To determine whether a "lay" rater could assess clinical reasoning, interrater reliability was measured between physician and lay raters of patient notes written by medical students as part of an 8-station objective structured clinical examination.
Methods:
Seventy-five notes were rated on core elements of clinical reasoning by physician and lay raters independently, using a scoring guide developed by physician consensus. Twenty-five notes were rerated by a 2nd physician rater as an expert control. Kappa statistics and simple percentage agreement were calculated in 3 areas: evidence for and against each diagnosis and diagnostic workup.
Results:
Agreement between physician and lay raters for the top diagnosis was as follows: supporting evidence, 89% (κ = .72); evidence against, 89% (κ = .81); and diagnostic workup, 79% (κ = .58). Physician rater agreement was 83% (κ = .59), 92% (κ = .87), and 96% (κ = .87), respectively.
Conclusions:
Using a comprehensive scoring guide, interrater reliability for physician and lay raters was comparable with reliability between 2 expert physician raters.
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