An Internationally Validated Direct Observation of Clinical Skills Rubric for Subjective Refraction

Amy Jost, Heather Connor, Aaron Shulka, Sophia Fang, Padraig Mulholland, Shailaja Reddy, Karl Golnik

Research output: Contribution to journalArticlepeer-review

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Background: Globally, refractive error is the most common cause of correctable vision impairment. Refractometry is a skill that is difficult for beginners to learn and challenging for the evaluators to assess. A well-constructed rubric can provide guidance as a teaching tool to the novice refractionist and as an assessment tool to the instructor.

Purpose: A new rubric was created to provide clinical educators with an internationally valid and standardized method to teach and assess competency in subjective refractometry.

Methods: A panel of seven international content experts participated in a qualitative research study to create a distance vision subjective manifest refractometry rubric by identifying the key steps of the procedure, determining performance levels of competency, and creating behavioral descriptors for each procedural step and level of competency. The rubric was reviewed by a total of 34 international subject-matter experts from 18 countries and from various roles, to ensure content validity.

Results: A 15-step rubric for subjective refraction was created. Levels of competency were defined as novice, beginner, advanced beginner and competent. Precise descriptions of performance were determined for each step at each performance level. Content validity was achieved by incorporating reviewer’s comments.

Conclusions: This internationally valid and standardized rubric is an assessment tool that can be applied globally to teach and assess distance vision manifest subjective refraction.
Original languageEnglish
Pages (from-to)86-92
Number of pages6
JournalActa Scientific Ophthalmology
Issue number8
Publication statusPublished (in print/issue) - 20 Jul 2022


  • Subjective Refraction
  • Refraction
  • Rubric
  • Refractive Error
  • Refractionist


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