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CLINICAL REASONING DEVELOPMENT IN UNDERGRADUATE MEDICAL EDUCATION: VALIDATION OF A NEW CLINICAL REASONING TEST

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ana silva

on 29 August 2011

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Transcript of CLINICAL REASONING DEVELOPMENT IN UNDERGRADUATE MEDICAL EDUCATION: VALIDATION OF A NEW CLINICAL REASONING TEST

Can equals be different? Ana L Da Silva, Reg Dennick
University of Nottingham, Nottingham, UK
mcxals1@nottingham.ac.uk AMEE, 2011 Vienna, Autria Present a Clinical Reasoning Test (CRT) for undergraduate Medical Education By Experts
By Students Background: Empirical data & Literature
Key features
The CRT Further research & discussion Validation (Qualitative) All rights reserved by Balakov Art? Magic? Training? Science
or art? How doctors think? How doctors get to the right diagnosis? Norman, G. (2005), Medical Education 39: 418–427. doi: 10.1111/j.1365-2929.2005.02127.x MUTUAL INTERESTS Kathryn Montgomery, 2006
Jerome E. Groopman, 2007 "Our job as educators is to continue to evolve our teaching methods in the hope that our students become more efficient and more accurate problem solvers and make fewer cognitive errors."
Kassirer, J. P. (2010). Academic Medicine, 85(7), 1118-1124. Empirical data & Literature Experts & Students Validation: Background: " SCTs probe examinees on a specific clinical reasoning task: data interpretation, a crucial step in the clinical reasoning process." 4 formative CRAs in the 2008-09 academic session Analysis of students results Analysis of the students feedback Discrimination and difficulty
Differences between good answers and not so good
Patterns of answers
Literature on reasoning errors
Students opinions and suggestions Focus groups Suggest 2 tests that you would arrange now [1/2 mark each], and explain their importance in explaining Mrs Docherty’s symptoms [1 mark each]. (example of question with high difficulty level ) I would ask her about her family and social history
(example of student answer) Feedback survey Essentially, I think it's an exciting, definately nerve wracking idea........(…) enjoyed the exam......although next time, perhaps be kinder.......I left the exam in a semi...."Oh My GOD!!!!".......and the other half of me was crying whilst pulling at my hair in frustration.....PURE EVIL!!!! :) (example of student overall opinion on the Assessment) Patient's Management Problems
PMP's (Rimoldi, H. J, 1961) Critiques Scoring method
Erros are cumulative
Decision tree schema (guides)
Do not give diagnosis of students strenths and weaknesses
Alternative (cue effect)
..... Our approach Based CRT in the idea
New scoring method
COMPUTER based & Unidirectional
Short answer questions (no alternatives or cues) Diagnostic Thinking Inventory
DTI (Bordage, G. 1990) Critiques Our approach Self-reported
Focus on diagnostic
Does not distinguish between diferent types of reasoning strategies Questions were designed to assess the behaviours
Categories and sub categories were converted into a marking scheme (scale) Script Concordance Test
SCT (Chalin et al, 2000) Fournier, J. P., Demeester, A., & Charlin, B. (2008). BMC 8, 18. Bordage, G. (1999). Academic Medicine, 74(10). Bordage G., Grant J., & Marsden, P. (1990). Medical Education, 24, 413-425.
Bordage, G., Brailovsky, C., Carretier, H., & Page, G. (1995). AcadMed 70(4), 276-281.
Bordage, G. (2007). Medical education, 41(12), 1117-21. Groves, M., Scott, I., & Alexander, H. (2002). Medical teacher, 24(5), 507-15. McGuire and Babbott (1967)
Simulated patient-problem technic (Williamson, 1965)
Diagnostic Management Problems (DMP) Helfer and Slater (1971)
Case Study Problems (Fleisher, 1972) Berner, E. S., Hamilton Jr., L. A., & Best, W. R. (1974). Journal of Medical Education. 49(7):666-72, July 1974. CRT Key Features: 4 cases selected based on WHO prevelance Non typical presentations Audio file Several types of questions Unidirectional

Based on few long/medium cases

21 questions (per case)
17 case based questions
1 knowledge question
1 "have you ever encountered this case"
1 confidence question
1 decision making question (What was more importante in you decision History, Physical...)

Questions sequence repeats Sweller, J. (1988). Cognitive Science, 12(2), 257-285. Short answer
MCQ
Extended match
SCT
Yes/No
"other" option Several types of questions Several types of questions Sudoku Game Professor of Medical School (Medical Background)
Clinical Fellow at the Medical Education Unit (Surgical background)
Medical Educator, expert in assessment in Medical Education
Course Director of a Medical School
A Reumathologist (practicioner), also teacher at a Medical School Conclusion:
Some aspects were identified and corrected due to this review
The CRT clinical content was solid
The structure and sequency of questions was viewed as positive Medical Students
with 1 semester of CP Answer the CRT
Focus Group Conclusions:
Average time 1 hour (not all questions)
Difficult questions: "know what to expect from clinical investigations"
SCT questions was interesting
Enjoyed the test (4 in a 1-5 scale)
Helpfull preparation for practice "Good sequence, it is waht you find in clinical practice" "I really felt this was testing my thinking process" "It would be easy if I had revised" "Real" " Technical aspects" And Next? N.Y. Louis Lee, Geoffrey Goodwin, P. N. Johnson-Laird (2008)
Thinking & Reasoning 14 (4) p. 342-364 H Süß (2002) Intelligence 30 (3) p. 261-288 Questions?
Suggestions?
mcxals1@nottingham.ac.uk Exploratory study of differences and similarities in Clinical Reasoning
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