Assessing therapist competence: the development of a performance-based measure and its comparison with an web-based measure

Background: Recent research interest in how best to train therapists to deliver psychological treatments has highlighted the need for rigorous, but scalable, means of measuring therapist competence. There are at least two components involved in assessing therapist competence: the assessment of their knowledge of the treatment concerned, including how and when to use its strategies and procedures, and an evaluation of their ability to apply such knowledge skilfully in practice. While the assessment of therapists’ knowledge has the potential to be completed efficiently online, the assessment of skill has generally involved a labour intensive process carried out by clinicians and as such may not be suitable for assessing training outcome in certain circumstances. Objective: To develop and evaluate a role-play based measure of skill suitable for assessing training outcome and to compare its performance with a highly scalable online measure of applied knowledge. Methods: Using enhanced cognitive behavioural therapy (CBT-E) for eating disorders as an exemplar, clinical scenarios for role-play assessment were developed and piloted together with a rating scheme for assessing trainee therapists’ performance. These scenarios were evaluated by examining the performance of 93 therapists from different professional backgrounds and at different levels of training in implementing CBT-E. These therapists also completed a previously developed online measure of applied knowledge and the ability of the online measure to efficiently predict competence on the role-play measure was investigated. Results: The role-play measure assessed performance at implementing a range of CBT-E procedures. The majority of the therapists rated their performance as moderately, or closely resembling their usual clinical performance. Trained raters were able to achieve good to excellent reliability for averaged competence, with intraclass correlation coefficients ranging from .653- .909. The measure was also sensitive to change with scores being significantly higher after training than before as might be expected (mean difference 0.758, P<0.001) even when taking account of repeated data (mean difference 0.667, P<0.001). The major shortcoming of the role-play measure was that it required considerable time and resources. This shortcoming is inherent in the method. Given this, of most interest for assessing training outcome, scores on the online measure efficiently predicted therapist competence, as judged by the role-play measure (with the online measure having a positive predictive value of 77% and specificity of 78%). Conclusion: The results of the present study suggest that while it was feasible and acceptable to assess performance using the newly developed role play measure, the highly scalable online measure could be used in certain circumstances as a substitute for the more labour-intensive and hence more costly role-play method