Marta A. King,Saint Louis University,St. Louis,MO,Carrie Phillip,Oregon Health & Science University,Portland,Oregon,Stuart J. Slavin,Saint Louis University,St Louis,MO,Paula Buchanan,Saint Louis University,St Louis,MO,Linda O. Lewin,University of Maryland School of Medicine,Baltimore,MD
The written history and physical (H&P) reflects medical students’ skills in information gathering, clinical reasoning, written communication, and at times systems-based practice and practice-based improvement. It is potentially a rich source of meaningful evaluation data. No evaluation tool has been validated across multiple institutions or with raters of different training levels.
To develop and validate a practical, easily administered written Pediatric History and Physical Exam Evaluation (P-HAPEE) rubric.
IRB approval was obtained at three participating institutions. The 10-item rubric was drafted after literature review, pilot tested, and revised based on broad input from experienced pediatric educators. A representative sample of 30 medical student written H&P’s from three institutions will be scored by 11 attending and 5 senior residents from three institutions. Intra-class correlation coefficients (ICCs) will be calculated to determine inter-rater reliability. Average H&P rating times and volunteer rater survey responses will be determined using descriptive statistics.
To date, 5 attendings and 2 senior residents have each scored 10 H&P’s using the P-HAPEE rubric. Preliminary results showed an ICC of 0.943 (95% CI= 0.866 – 0.984) for the whole rubric. Individual section ICC’s were also high: 0.903 (95% CI= 0.396 – 0.998) for history; 0.945 (95% CI= 0.751 – 0.999) for physical exam/diagnostic studies, 0.972 (95% CI = 0.887 – 0.998) for assessment/plan. Attendings had higher reliability than senior residents with ICC of 0.933 (95% CI = 0.834 – 0.981) compared to 0.789 (95% CI = 0.686 – 0.858). Mean time to review and score an H&P was 16.5 minutes (SD=6.8). All raters described the rubric’s ease of use as good or very good and endorsed interest in utilizing it to provide structured written H&P feedback.
The P-HAPEE rubric might provide a reliable method of evaluating written H&P’s and proving students with documentation feedback. Stronger inter-rater reliability of our rubric compared to previously published tools likely reflects both the extensive multi-source review involved in creating the instrument as well as the inclusion of specific anchors to guide scoring.