The Pediatric Examination Assessment Rubric (PEAR) toolkit: reliability study

Background: The Pediatric Examination Assessment Rubric (PEAR) toolkit consists of an examination sheet and rubric designed to assess ophthalmology residents’ performance on the pediatric eye examination. The purpose of this study was to evaluate the reliability of the PEAR toolkit.

Methods: Six ophthalmology residents (2 PGY-2, 4 PGY-3) at a single ACGME-accredited US program participated in 11 video-recorded pediatric ophthalmology patient encounters. Two pediatric ophthalmologists reviewed the videos and the residents’ examination sheets to complete a PEAR evaluation. The inter-rater reliability of the rating for each of the 12 examination skills evaluated using PEAR was determined using kappa statistics, and reliability strength was categorized based on published guidelines (≤0, poor; 0-0.20, slight; 0.21-0.40, fair; 0.41-0.60, moderate; 0.41-0.60, substantial; 0.81-1.00, almost perfect).

Results: Eleven video encounters were completed. Of the 12 examination skills evaluated using PEAR, 9 had kappa scores with strengths of moderate to almost perfect reliability. Two examination skills, Worth 4-Dot and alignment, showed fair reliability. A kappa score could not be calculated for stereoacuity because of the lack of variability among the evaluators’ raw scores.

Conclusions: In our small sample of residents from a single institution, the PEAR toolkit showed inter-rater reliability.


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Work Title The Pediatric Examination Assessment Rubric (PEAR) toolkit: reliability study
Open Access
  1. Michael Langue
  2. Ingrid Scott
  3. Amanda L Ely
  4. Ajay Soni
License CC BY-NC-ND 4.0 (Attribution-NonCommercial-NoDerivatives)
Work Type Article
  1. Journal of American Association for Pediatric Ophthalmology and Strabismus
Publication Date December 2020
Publisher Identifier (DOI)
  1. 10.1016/j.jaapos.2020.08.012
Related URLs
Deposited August 02, 2021




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  • Added Creator Amanda L Ely
  • Added Creator Ajay Soni
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