From: Use of the confusion assessment method in multicentre delirium trials: training and standardisation
Initial training and standardisation | |
 Didactic overview | • Classroom: guided review of the CAM Training Manual |
• Interactive review and scoring of training videos | |
 Individual practice sessions | • Paired practice interviews with an experienced delirium assessor |
• Mimic 2 patients with and 2 patients without delirium | |
 Pilot interviews with patients | • Experienced delirium assessor observes new research assistant interviewing patients and gives feedback |
• Interview 2 delirium and 2 non-delirium patients | |
 Inter-rater reliability assessments (baseline standardisation) | • Pairs of interviewers observe same patients and score CAM independently |
• After interview, compare and discuss ratings | |
• Continue until 100% agreement achieved | |
• Minimum of 2 delirium and 5 non-delirium patients | |
• Early pairs should include experienced delirium assessor | |
 CAM-only training | • Intended to score cases where patients are poorly responsive or interviews are incomplete |
• Training to code CAM features based on bedside observations. If patients unresponsive, may only be able to code altered level of consciousness | |
Ongoing monitoring and performance checks | |
 Coding sessions | • Regularly scheduled meetings to discuss any questions on coding the CAM features |
• Involve project directors and key staff from each study site, and include at least one delirium expert clinician | |
• Minimum of 2 times per month (ideally weekly) throughout the study | |
• Use sessions as opportunity for retraining | |
 Ongoing inter-rater reliability Assessments (performance checks) | • Local: all staff undergo paired ratings with experienced delirium assessor at the site; ratings compared and discussed. Recommend: every 6 months throughout study |
• Cross-site: One gold-standard expert rater performs spot checks at all study sites with inter-rater assessments at least once per year. Alternative approaches may utilise videoconferencing or face-time for inter-rater assessments across sites. | |
 New staff training | • Complete all steps of initial training when any new staff member joins the study to maintain high quality ratings |
• Verify inter-rater reliability with existing staff |