Initial tool had 25 Items modified from the professional behaviors on the ... professional autonomy. Despite the ... MGH Institute of Health Professions, Boston, MA.
Validation of a Clinical Decision-Making Tool Using Rasch Analysis
Tracy Brudvig PT, DPT, PhD, OCS, Kelly Macauley PT, DPT, CCS, GCS, Amanda Barry, PT, DPT, ATC, Olivia Lufkin, PT, DPT, Kevin McEnroy, PT, DPT, and Andrew Milinazzo, PT, DPT MGH Institute of Health Professions, Boston, MA
INTRODUCTION
RESULTS
Clinical decision-making (CDM) is a process, involving critical thinking and problem solving. Clinical decision-making is essential for effective patient care and professional autonomy. Despite the importance of developing sound CDM skills for physical therapy practice, no easy-to-use, validated, self-report CDM tool exists in PT.
Ceiling Effect
PURPOSE The purpose of the study was to validate a tool to assess baseline levels and subsequent development of CDM skills in doctor of physical therapy (DPT) students.
METHODS • Initial tool had 25 Items modified from the professional behaviors on the PTCPI ,assessed on a 6 point Likert scale • Initial content and face validity of tool was established from expert consensus • Pilot study showed content validity of tool by comparing students’ perceptions of their CDM to that of their clinical instructors perceptions of the student’s CDM, and assessing student’s perception compared to a narrative on their CDM • Results lead to cross-sectional data collection using a sample of convenience of DPT students in Northeast US • Four phases of data collection on 4 iterations of the tool occurred, using Rasch analysis to assess and modify each version: 1. August 2013 – August 2014, n=178 2. January 2015 – February 2015, n=66 3. April 2015 – November 2015, n=130 4. May 2016 – July 2016, n=156
RESULTS • Tool demonstrated high internal consistency • Tool is unidimensional, measuring 1 construct: CDM • During each phase, the tool was modified to better measure subject ability, a larger range of abilities, and to reduce item redundancy • In the 3rd phase, the DECIDE model was used as a theoretical framework to reduce redundancy in items (tool collapsed from 25 to 12 items) • Kruskall-Wallis showed a difference in CDM between class years less than 1 year after internship
Rasch models assume unidimensionality. The analysis demonstrates we are measuring 1 construct, which we believe to be clinical decision making.
The sample probability curve demonstrates a clear distinction between levels of the Likert scale. All items on the tool had similar probability curves.
The ceiling and floor effect accounts for 22% of the sample. The ceiling effect consists of subjects > 1 year from graduation. The floor effect consisted of new 1st year students.
Floor Effect
CONCLUSIONS • The CDM tool has undergone a rigorous developmental process and differentiates well between different levels of CDM. • The tool demonstrates differences in CDM ability between students less than 1 year after internship. • This tool’s usefulness in PT education includes continuing to compare different groups of DPT students and using it as an outcome measure following the implementation of various innovative teaching initiatives. • Given the generic question design, it is likely that this tool can be used across professions or for interprofessional activities. • Further research opportunities to evaluate tool at other institutions, establish cut points, sensitivity to change, and applicability to other professions is needed.
Scan me for the CDM Tool!
