Development, Validation, and Implementation of a Medical Judgment Metric.

Development, Validation, and Implementation of a Medical Judgment Metric.

Ahmed Rami A; McCarroll Michele L; Schwartz Alan; Gothard M David; Atkinson S Scott; Hughes Patrick G; Cepeda Brito Jose Ramon; Assad Lori; Myers Jerry G; George Richard L

MDM policy & practice

2017

2017-06

Background: Medical decision making is a critical, yet understudied, aspect of medical education. Aims: To develop the Medical Judgment Metric (MJM), a numerical rubric to quantify good decisions in practice in simulated environments; and to obtain initial preliminary evidence of reliability and validity of the tool. Methods: The individual MJM items, domains, and sections of the MJM were built based on existing standardized frameworks. Content validity was determined by a convenient sample of eight experts. The MJM instrument was pilot tested in four medical simulations with a team of three medical raters assessing 40 participants with four levels of medical experience and skill. Results: Raters were highly consistent in their MJM scores in each scenario (intraclass correlation coefficient 0.965 to 0.987) as well as their evaluation of the expected patient outcome (Fleiss's Kappa 0.791 to 0.906). For each simulation scenario, average rater cut-scores significantly predicted expected loss of life or stabilization (Cohen's Kappa 0.851 to 0.880). Discussion: The MJM demonstrated preliminary evidence of reliability and validity.

clinical judgment; decision making; medical judgment; simulation

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