However, it has implications for students whose score is within the borderline pass/fail range. If the pass mark is 40 out of the total 80 marks on the 20 items, then 40 minus 6.5 (33.5) might be considered an outright fail, while 40 plus 6.5 (46.5) might be considered an outright pass. The values in between would require

a process for deciding on further assessment for confidence that the student has an adequate level of professional competence. There are many possible sources of error in assessment scores and these are likely to be related to circumstances, educator, student, and the interaction of these factors. If other indicators of student ability indicated competency, GW786034 in vivo a mark as low as 34 may be acceptable. Alternatively, if other assessments indicate a student consistently performs in the borderline range, further practice and assessment PD98059 concentration (or tailored remediation) may be triggered even by grades as high as 47. Norman et al (2003) reported that for health-related quality of life outcome measures, the change in measures of health outcomes that people typically consider to be important (minimal important difference) is approximately half a standard deviation of raw scores for a representative cohort. If the APP scores behaved as quality of life scores do, then an estimate of the possible minimally important difference would be 6–8 points, a proposal that warrants investigation. There will always be some

lack of agreement between raters and defining the limits of tolerable disagreement is challenging. Some variability would be expected due to the unpredictable challenges of a complex health services environment combined with variable opportunities for

educators to observe student ability across the spectrum of clinical skills. Despite these challenges, in this interrater reliability trial the physiotherapy clinical educators demonstrated a high level of consistency in the assessment and marking of physiotherapy students’ performance on clinical placements when using the Assessment of Physiotherapy Practice. Ethics: Approval for the study was provided by the Human Ethics Committees of Monash University and from the Human Ethics Committees of each of the participating universities. All participants gave written informed either consent before data collection began. Competing interests: Nil. Support: Funding from the Australian Learning and Teaching Council (ALTC) enabled employment of a research assistant and travel to conduct focus groups and training workshops. The authors acknowledge the assistance of Curtin, James Cook, La Trobe, Griffith, Monash, and Sydney Universities and thank the clinical educators and students who participated. “
“Summary of: Hill JC et al (2011) Comparison of stratified primary care management for low back pain with current best practice (STarT Back): a randomised controlled trial. Lancet 378: 1560–1571. Published Online September 29, 2011 DOI:10.