Assessing clinical reasoning in undergraduate medical students during history taking with an empirically derived scale for clinical reasoning indicators

BMC Medical Education

Tillmann Helm¹  Sophie Fürstenberg¹  Sigrid Harendza¹  Sarah Prediger¹  Martina Kadmon²  Pascal O. Berberat³ 

[1] Department of Internal Medicine, University Medical Center Hamburg-Eppendorf, III Medizinische Klinik, Martinistr. 52, D-20246, Hamburg, Germany;Faculty of Medicine, University of Augsburg, Deanery, Augsburg, Germany;TUM Medical Education Center, School of Medicine, Technical University of Munich, Munich, Germany;

关键词: Assessment;    Clinical reasoning;    Competence;    History taking;    Medical education;   

DOI  :  10.1186/s12909-020-02260-9

来源: Springer

【 摘 要 】

BackgroundThe clinical reasoning process, which requires biomedical knowledge, knowledge about problem-solving strategies, and knowledge about reasons for diagnostic procedures, is a key element of physicians’ daily practice but difficult to assess. The aim of this study was to empirically develop a Clinical Reasoning Indicators-History Taking-Scale (CRI-HT-S) and to assess the clinical reasoning ability of advanced medical students during a simulation involving history taking.MethodsThe Clinical Reasoning Indictors-History Taking-Scale (CRI-HT-S) including a 5-point Likert scale for assessment was designed from clinical reasoning indicators identified in a qualitative study in 2017. To assess indicators of clinical reasoning ability, 65 advanced medical students (semester 10, n = 25 versus final year, n = 40) from three medical schools participated in a 360-degree competence assessment in the role of beginning residents during a simulated first workday in hospital. This assessment included a consultation hour with five simulated patients which was videotaped. Videos of 325 patient consultations were assessed using the CRI-HT-S. A factor analysis was conducted and the students’ results were compared according to their advancement in undergraduate medical training.ResultsThe clinical reasoning indicators of the CRI-HT-S loaded on three factors relevant for clinical reasoning: 1) focusing questions, 2) creating context, and 3) securing information. Students reached significantly different scores (p < .001) for the three factors (factor 1: 4.07 ± .47, factor 2: 3.72 ± .43, factor 3: 2.79 ± .83). Students in semester 10 reached significantly lower scores for factor 3 than students in their final year (p < .05).ConclusionsThe newly developed CRI-HT-S worked well for quantitative assessment of clinical reasoning indicators during history taking. Its three-factored structure helped to explore different aspects of clinical reasoning. Whether the CRI-HT-S has the potential to be used as a scale in objective structured clinical examinations (OCSEs) or in workplace-based assessments of clinical reasoning has to be investigated in further studies with larger student cohorts.

【 授权许可】

CC BY