Professional Evaluation & Reflection on Change Tool (PERFECT)

Purpose

The Professional Evaluation & Reflection on Change Tool (PERFECT) is a critical incident tool that was designed for use by health professionals to explore change and reason for change in clinical practice.

In-Depth Review

Purpose of the measure

The Professional Evaluation & Reflection on Change Tool (PERFECT) is a standardized tool that facilitates analysis of change and reason for change in clinical practice over the past 6 and 12 months (Menon et al., 2010). It explores clinical practice in terms of four domains of (i) problem identification, (ii) assessment, (iii) treatment, and (iv) referral practices.

Available versions

There is only one version of the PERFECT, which was developed by Korner-Bitensky, Menon, Cafaro, Loncaric, Moore, Vivona and Wynands in 2010.

Features of the measure

Items:
The PERFECT is designed to be administered in interview format. In addition to a brief section on the clinician’s professional demographics (e.g. age, gender, work setting, participationAs defined by the International Classification of Functioning, Disability and Health, participation is an individual’s involvement in life situations in relation to health conditions, body functions or structures, activities, and contextual factors. Participation restrictions are problems an individual may have in the manner or extent of involvement in life situations. in clinical education), there are four sections with a total of 33 questions. The four domains of practice are:

• Problem identification
• Assessment practices
• Treatment practices
• Referral patterns

Within each of these four domains the clinician is required to reflect on his/her clinical practice over the past 6 and 12 months, to consider changes made, the reasons for change, enablers and barriers to change, and additional change desires.

Scoring and Scoring Interpretation:
N/A

Equipment:
N/A

Time:
30 minutes

Training requirement:
No training requirements specified

Subscales:
None

Alternative forms of the PERFECT

None.

Client suitability

• The PERFECT was designed as a research tool for rehabilitation professionals. Further psychometric testing is recommended for broader use.

In what languages is the measure available?

• English.

Summary

What does the tool measure?	Change and reason for change in clinical practice by health professionals.
What types of clients can the tool be used for?	Rehabilitation clinicians
Is this a screeningTesting for disease in people without symptoms. or assessment tool?	N/A
Time to administer	Approximately 30 minutes
Versions	There are no alternative versions.
Other Languages	There are no official translations.
Measurement Properties
ReliabilityReliability can be defined in a variety of ways. It is generally understood to be the extent to which a measure is stable or consistent and produces similar results when administered repeatedly. A more technical definition of reliability is that it is the proportion of “true” variation in scores derived from a particular measure. The total variation in any given score may be thought of as consisting of true variation (the variation of interest) and error variation (which includes random error as well as systematic error). True variation is that variation which actually reflects differences in the construct under study, e.g., the actual severity of neurological impairment. Random error refers to “noise” in the scores due to chance factors, e.g., a loud noise distracts a patient thus affecting his performance, which, in turn, affects the score. Systematic error refers to bias that influences scores in a specific direction in a fairly consistent way, e.g., one neurologist in a group tends to rate all patients as being more disabled than do other neurologists in the group. There are many variations on the measurement of reliability including alternate-forms, internal consistency , inter-rater agreement , intra-rater agreement , and test-retest .	Not yet examined
ValidityThe degree to which an assessment measures what it is supposed to measure.	Content: Preliminary review by an expert panel has verified satisfactory content validityRefers to the extent to which a measure represents all aspects of a given social concept. Example: A depression scale may lack content validity if it only assesses the affective dimension of depression but fails to take into account the behavioral dimension. . Criterion: Concurrent validityTo validate a new measure, the results of the measure are compared to the results of the gold standard obtained at approximately the same point in time (concurrently), so they both reflect the same construct. This approach is useful in situations when a new or untested tool is potentially more efficient, easier to administer, more practical, or safer than another more established method and is being proposed as an alternative instrument. See also “gold standard.” has not been examined as there is no gold standardA measurement that is widely accepted as being the best available to measure a construct. for assessing change in clinical practice amongst health professionals. Construct: N/A Face: Preliminary review by an expert panel has verified satisfactory face validityA form of content validity, face validity is assessed by having ‘experts’ (this could be clinicians, clients, or researchers) review the contents of the test to see if the items seem appropriate. Because this method has inherent subjectivity, it is typically only used during the initial phases of test construction. .
Floor/Ceiling Effects	N/A
Does the tool detect change in patients?	N/A
Acceptability	The PERFECT is simple to administer and provides specific instructions for the assessor to follow. Minimal equipment is required.
Feasibility	Administration of the S-5 is quick and easy, and can be performed by any member of the multidisciplinary team. Feedback from expert clinicians and patients indicates acceptable administration time, effort and complexity.
How to obtain the tool?	Click here to see a copy of the PERFECT

Psychometric Properties

Overview

We conducted a literature search to identify all relevant publications on the psychometric properties of the PERFECT. We identified 1 study.

Floor/Ceiling Effects

N/A

Reliability

Internal ConsistencyA method of measuring reliability . Internal consistency reflects the extent to which items of a test measure various aspects of the same characteristic and nothing else. Internal consistency coefficients can take on values from 0 to 1. Higher values represent higher levels of internal consistency.:
N/A

Intra-rater:
N/A

Inter-rater:
N/A

Validity

Content:
Five expert reviewers in the field of strokeAlso called a “brain attack” and happens when brain cells die because of inadequate blood flow. 20% of cases are a hemorrhage in the brain caused by a rupture or leakage from a blood vessel. 80% of cases are also know as a “schemic stroke”, or the formation of a blood clot in a vessel supplying blood to the brain. and knowledge translation research reviewed the PERFECT for face validityA form of content validity, face validity is assessed by having ‘experts’ (this could be clinicians, clients, or researchers) review the contents of the test to see if the items seem appropriate. Because this method has inherent subjectivity, it is typically only used during the initial phases of test construction.
(Menon et al., 2010). Please refer to the article by Menon et al. (2010) for information regarding the psychometric properties of the PERFECT. Pilot-testing with a small (n=10) convenience sample indicated the need for consideration of other areas of clinical practice such as discharges, patient involvement and self-directed learning, however it was considered that these areas are partly included within the four practice domains of the questionnaire.

Criterion:
Concurrent:
N/A

Predictive.
N/A

Construct:
N/A

Face:
Five expert reviewers in the field of strokeAlso called a "brain attack" and happens when brain cells die because of inadequate blood flow. 20% of cases are a hemorrhage in the brain caused by a rupture or leakage from a blood vessel. 80% of cases are also know as a "schemic stroke", or the formation of a blood clot in a vessel supplying blood to the brain. and knowledge translation research reviewed the PERFECT for face validityA form of content validity, face validity is assessed by having 'experts' (this could be clinicians, clients, or researchers) review the contents of the test to see if the items seem appropriate. Because this method has inherent subjectivity, it is typically only used during the initial phases of test construction.
(Menon et al., 2010). Further pilot-testing with a small (n=10) convenience sample of rehabilitation clinicians indicated that the PERFECT was successful in prompting exploration of change, reasons for change, and facilitators and barriers to change in participants’ clinical practice. Please refer to the article by Menon et al. (2010) for information regarding the psychometric properties of the PERFECT.

Responsiveness

N/A

References

• Menon, A., Cafaro, T., Loncaric, D., Moore, J., Vivona, A., Wynands, E. & Korner-Bitensky, N. (2010). Creation and validation of the PERFECT: a critical incident tool for evaluating change in the practices of health professionals. Journal of E

See the measure

How to obtain the PERFECT?

The PERFECT can be obtained by clicking on the following link: PERFECT  (PDF)