CRA Grid - A preliminary development and calibration of a paper-based objectivization of caries risk assessment in undergraduate dental education

CONTEXT: Caries risk assessment (CRA) varies between students and faculty due to the subjectivity inherent in the process as well as in the critical thinking skills required for the processing of information. AIMS: The aim was to develop a paper-based, grid system, CRA-Grid, to objectivize and standardize risk assessment and to assess its rating agreement with the critical thinking process of the teachers. SETTINGS AND DESIGN: The CRA-Grid was developed and tested in a clinical study, in Indira Gandhi Institute of Dental Sciences, Puducherry. MATERIALS AND METHODS: Based on the currently available evidence, specific weightages were assigned to the risk factors in an existing CRA form. A 10 × 10 paper grid was created incorporating these weightages. Shading and summing up the respective squares in the grid provided a percentage score. The class interval of percentage indicating the risk status was determined using historical clinical data. After training, the students performed CRA of 57 patients by using the CRA-Grid. Six faculties were blinded to these scores and assessed the risk by critical thinking process. STATISTICAL ANALYSIS USED: Cohen's weighted kappa (k) for inter-rater agreement was run using Graph Pad QuickCalcs. RESULTS: Cohen's weighted kappa for agreement at 95% confidence interval, between the CRA-Grid and critical thinking process, ranged from “good” to “very good.” Mean percentage of agreement of the six faculty was 79.6%; and with caries grid, was 80.5%. CONCLUSIONS: Risk assessment with the paper-based, objectivized, CRA-Grid matched that done by critical thinking process.