Contents lists available at ScienceDirect Nurse Education in Practice journal homepage: www.elsevier.com/locate/nepr Original research Psychometric properties of the virtual patient version of the Lasater Clinical Judgment Rubric Carina Georg a,b,* , Elisabet Welin c , Maria Jirwe d,b , Klas Karlgren a,e , Johanna Ulfvarson b a Department of Learning, Informatics, Management and Ethics, Karolinska Institutet, Stockholm, Sweden b Department of Neurobiology, Care Sciences and Society, Division of Nursing, Karolinska Institutet, Huddinge, Sweden c School of Health Sciences, Örebro University, Örebro, Sweden d Department for Health Promoting Science, Sophiahemmet University, Stockholm, Sweden e Department of Research, Education, Development and Innovation, The Södersjukhuset Hospital, Stockholm, Sweden ARTICLE INFO Keywords: Nursing education Clinical reasoning Rubric Virtual patients ABSTRACT A number of studies attest to the effectiveness of virtual patients in fostering and assessing students' development of clinical reasoning. An objective assessment of students' clinical reasoning is, however, challenging. This study focused on determining the psychometric properties of the virtual patient version of the Lasater Clinical Judgment Rubric, a rubric that is aimed at assessing nursing students' clinical reasoning processes when en- countering virtual patients. A nonexperimental design was used in which data from 125 students' reflections on solving two different virtual patient scenarios were included in the analysis. First, a deductive content analysis was conducted using the categories of the rubric as a lens. After that, each student's performance was quantified according to the different levels of the rubric. Exploratory factor analysis and test of normality and reliability, including the Kaiser-Meyer-Olkin test, Bartlett's test, the Shapiro-Wilk test, and Cronbach's alpha were used in the analysis. The result suggested three factors: “Understanding the patient”, “Care planning” and “Reflecting” that explained 81.8% of the variance. Cronbach's alpha was 0.931. The result showed the rubric to be a valid assessment instrument for assessing nursing students' clinical reasoning when encountering virtual patients. 1. Introduction Clinical reasoning is a basic skill and a cornerstone competency of nursing practice. Therefore, nursing students' development of clinical reasoning skills is a major goal of the nursing education system (Hunter and Arthur, 2016; Jessee and Tanner, 2016). Supporting nursing stu- dents to develop appropriate clinical reasoning skills is nevertheless a challenge for the education system (Pennaforte et al., 2016) and edu- cators struggle with how to teach and evaluate nursing students' clinical reasoning abilities (Delany and Golding, 2014; Pinnock and Welch, 2014). Virtual patients have been acknowledged as well suited for teaching, learning and assessing health-care students' development of clinical reasoning skills (Cook and Triola, 2009; Cook et al., 2010; Hege et al., 2016). An objective assessment of students' clinical reasoning is however challenging, and most current methods for formative evalua- tion of health-care students' clinical reasoning in encounters with vir- tual patients do not account for the nonlinear nature of the clinical reasoning process (Hege et al., 2017). However, we have recently developed a rubric, the virtual patient version of the Lasater Clinical Judgment Rubric (vpLCJR), that is based on the Lasater Clinical judg- ment rubric (LCJR) (Lasater, 2007). The vpLCJR is designed to assess nursing students’ clinical reasoning processes when encountering vir- tual patients (Georg et al., 2018). This paper reports on the psycho- metric properties of the virtual patient version of the Lasater Clinical Judgment Rubric. 2. Background 2.1. Clinical reasoning The term ‘clinical reasoning’ is used in this article to describe the logical strategies and cognitive processes that form the basis for how “nurses collect cues, process the information, come to an understanding of a patient's problem or situation, plan and implement interventions, evaluate outcomes, and reflect and learn from these processes'” (Levett- Jones et al., 2010, p. 516). https://doi.org/10.1016/j.nepr.2019.05.016 Received 16 May 2018; Received in revised form 11 April 2019; Accepted 27 May 2019 * Corresponding author. Department of Neurobiology, Care Sciences and Society, Division of Nursing Karolinska Institutet, Huddinge, Sweden E-mail addresses: carina.georg@ki.se (C. Georg), elisabet.welin@oru.se (E. Welin), maria.jirwe@shh.se (M. Jirwe), klas.karlgren@ki.se (K. Karlgren), Johanna.Ulfvarson@ki.se (J. Ulfvarson). Nurse Education in Practice 38 (2019) 14–20 1471-5953/ © 2019 Published by Elsevier Ltd. T