Evaluating the Application of an EMS Clinical Judgment Theoretical Framework

Area of Science:

• Emergency Medical Services (EMS)
• Clinical Judgment (CJ)
• Medical Simulation

Background:

• Clinical judgment (CJ) is crucial in emergency medical services (EMS), involving clinical reasoning and decision-making.
• A theoretical model for EMS CJ exists but requires evaluation in training and assessment contexts.
• Assessing CJ objectively is vital for ensuring competent EMS providers.

Purpose of the Study:

• To evaluate the performance of a theoretical EMS CJ model in assessing clinical reasoning and decision-making.
• To determine the reliability and validity of an objective rubric for evaluating EMS clinical judgment in a simulated environment.

Main Methods:

• EMS clinician teams (2-3 members) managed a simulated older adult fall scenario in a home setting.
• Simulations were video-recorded and coded; clinical judgment was assessed using two methods: EMS Medical Director (MD) scoring and an objective rubric score based on the EMS CJ model.
• The rubric focused on cue recognition, action performance, and post-action re-evaluation, assessing four key CJ questions.

Main Results:

• Overall concordance between MD scores and rubric scores for clinical judgment decisions was 88.1%, exceeding the 70% validity threshold.
• Concordance for specific CJ questions ranged from 79.9% to 95.0%, indicating strong agreement across different aspects of clinical judgment.
• The objective rubric demonstrated high agreement with subjective expert evaluations.

Conclusions:

• An objective evaluation rubric, derived from a theoretical EMS CJ framework, shows high concordance with subjective EMS MD evaluations.
• This rubric-based approach offers a reproducible and objective method for assessing clinical judgment in EMS.
• The findings suggest this method can be effectively used for competency assessment in EMS training and practice.