Clinical vignettes in quality assurance: An instrument for evaluating therapists' diagnostic competence in personality disorders

Abstract

The structured interview for DSM-III-R (SCID) has been availavle for some time. Although it is commonly used, the knowledge of both its contribution to valid diagnostic assessment and the obtainable interrater reliability in ordinary clinical settings is limited. In a Norwegian national psychiatric hospital the SCID interviews both on Axis I and Axis II have been used since 1990. As the influence of various personality disorders on treatment outcome was the focus of our clinical work, we felt the need to ensure the quality of the diagnostic work being performed by use of SCID interviews, especially on Axis II. Fifteen of 19 therapists participated in this study for the purpose of estimating their competence in diagnosing personality disorders. Due to time and resource limitation in a busy clinical setting, we chose as a method clinical vignettes to be scored in accordance with the criteria of the DSM-III-R, Axis II. The interrater reliability obtained between the therapists' ratings and the standard diagnoses set by the authors within this design was comparable to that in studies with other and more demanding designs. We conclude that the use of clinical vignettes can be an appropriate and inexpensive method of quality assurance for estimating therapists' diagnostic competence in clinical settings, but further research is needed to confirm and increase the eneralizability of our results.

Key Words:

• Clinical vignettes
• Diagnostic competence
• Personality disorders
• Quality assurance