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Judging clinical competence using structured observation tools: A cautionary tale

Published online by Cambridge University Press:  15 April 2019

Anthony D. Roth ,
Pamela Myles-Hooton  and
Amanda Branson
Anthony D. Roth*
Affiliation:
Research Department of Clinical, Educational and Health Psychology, University College London, London, UK
Pamela Myles-Hooton
Affiliation:
Charlie Waller Institute, University of Reading, Reading, UK
Amanda Branson
Affiliation:
Charlie Waller Institute, University of Reading, Reading, UK
*
*Corresponding author. Email: a.roth@ucl.ac.uk
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Abstract

Background:

One method for appraising the competence with which psychological therapy is delivered is to use a structured assessment tool that rates audio or video recordings of therapist performance against a standard set of criteria.

Aims:

The present study examines the inter-rater reliability of a well-established instrument (the Cognitive Therapy Scale – Revised) and a newly developed scale for assessing competence in CBT.

Method:

Six experienced raters working independently and blind to each other’s ratings rated 25 video recordings of therapy being undertaken by CBT therapists in training.

Results:

Inter-rater reliability was found to be low on both instruments.

Conclusions:

It is argued that the results represent a realistic appraisal of the accuracy of rating scales, and that the figures often cited for inter-rater reliability are unlikely to be generalizable outside the specific context in which they were achieved. The findings raise concerns about the use of these scales for making summative judgements of clinical competence in both educational and research contexts.

Keywords

assessmentclinical supervisiontherapist competencetraining
Type
Main
Information
Behavioural and Cognitive Psychotherapy , Volume 47 , Issue 6 , November 2019 , pp. 736 - 744
Copyright
© British Association for Behavioural and Cognitive Psychotherapies 2019 

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