Using Psychological Scaling Techniques to Assess Clinical Expertise in Anesthesiology

This study used Pathfinder, a psychological scaling technique, to assess underlying cognitive structure associated with mastery of relevant knowledge necessary for anesthesiology decision-making. Our study revealed this approach to be a valid method to assess the tacit knowledge that underlies clinical expertise. A set of concepts associated with a decision-to-extubate scenario was derived from expert interviews. Participants included nine attending anesthesiologists, seven first-year anesthesiology residents, and eight second-year anesthesiology residents. Pathfinder was applied to participants’ pairwise relatedness judgments of the clinical concepts in the context of the scenario. Experts’ data were aggregated to form an expert referent structure. Student anesthesiologists were assessed based on comparison of their structures to this referent. These comparisons yielded a knowledge score that was highly correlated with residents’ exam grades. This finding supports our position that Pathfinder is a valid knowledge assessment method and, as a complement to current exams, can be applied to assess a student’s deep understanding of anesthesiology concepts.