Approaches to Assessing the Clinical Reasoning of Preclinical Students

Cate, Olle ten; Durning, Steven J.

doi:10.1007/978-3-319-64828-6_5

Cited by 15 publications

(21 citation statements)

References 29 publications

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“…They also offer greater insight into cognitive errors, thereby offering opportunities to hone teaching, feedback and learning, as well as creating summative assessments with greater validity. Unlike short-answer questions, modified essay formats or clinical reasoning problems,9 VSAs are straightforward to deliver in an electronic format and efficient to mark. We need to know that medical students and trainees have the required applied medical knowledge to practise safely without test scores being confounded by the ability to use the cues of SBA answer options.…”

Section: Resultsmentioning

confidence: 99%

“…Because patients do not present with a list of five possible diagnoses, investigations or treatment options,8 SBA questions do not simulate the ‘situations they [the candidates] will face when they undertake patient-related clinical tasks’ (p66) 9. Any alternative method of assessing applied medical knowledge must therefore provide increased content and response process validity, without resulting in significant reductions in other types of validity, reliability, acceptability, educational impact or an unacceptable increase in cost 10.…”

Section: Introductionmentioning

confidence: 99%

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Comparing single-best-answer and very-short-answer questions for the assessment of applied medical knowledge in 20 UK medical schools: Cross-sectional study

et al. 2019

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ObjectivesThe study aimed to compare candidate performance between traditional best-of-five single-best-answer (SBA) questions and very-short-answer (VSA) questions, in which candidates must generate their own answers of between one and five words. The primary objective was to determine if the mean positive cue rate for SBAs exceeded the null hypothesis guessing rate of 20%.DesignThis was a cross-sectional study undertaken in 2018.Setting20 medical schools in the UK.Participants1417 volunteer medical students preparing for their final undergraduate medicine examinations (total eligible population across all UK medical schools approximately 7500).InterventionsStudents completed a 50-question VSA test, followed immediately by the same test in SBA format, using a novel digital exam delivery platform which also facilitated rapid marking of VSAs.Main outcome measuresThe main outcome measure was the mean positive cue rate across SBAs: the percentage of students getting the SBA format of the question correct after getting the VSA format incorrect. Internal consistency, item discrimination and the pass rate using Cohen standard setting for VSAs and SBAs were also evaluated, and a cost analysis in terms of marking the VSA was performed.ResultsThe study was completed by 1417 students. Mean student scores were 21 percentage points higher for SBAs. The mean positive cue rate was 42.7% (95% CI 36.8% to 48.6%), one-sample t-test against ≤20%: t=7.53, p<0.001. Internal consistency was higher for VSAs than SBAs and the median item discrimination equivalent. The estimated marking cost was £2655 ($3500), with 24.5 hours of clinician time required (1.25 s per student per question).ConclusionsSBA questions can give a false impression of students’ competence. VSAs appear to have greater authenticity and can provide useful information regarding students’ cognitive errors, helping to improve learning as well as assessment. Electronic delivery and marking of VSAs is feasible and cost-effective.

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Section: Resultsmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Comparing single-best-answer and very-short-answer questions for the assessment of applied medical knowledge in 20 UK medical schools: Cross-sectional study

et al. 2019

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“…It is one of the most highly valued, practical, and low-cost courses in the curriculum. 28 , 29 A similar model might work for anatomy teaching and be cost-effective, even if it does not reduce infrastructure costs.…”

Section: What Are Ways Forward?mentioning

confidence: 99%

Are We Facing the End of Gross Anatomy Teaching as We Have Known It for Centuries?

Chan¹,

Stapper²,

Bleys³

et al. 2022

AMEP

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The status of anatomy education in undergraduate medical education has dramatically changed over the course of the past century. From the most important and time-consuming component of the preclinical program, anatomy education has reduced in size and status, and yielded in curricular space to accommodate other disciplines and topics. Meanwhile, radiology has become more prominent, as a means to visualize anatomy, not only in clinical care but also in education. For this perspective paper, the authors, all with backgrounds in anatomy, radiology and/or medical education, conducted structured conversations with several academic colleagues with similar backgrounds, reviewed pertinent literature and analyzed the causes of the historical decline of a knowledge domain of medical education, that nevertheless is widely considered essential for medical students and graduates. After this analysis, the authors propose four ways forward. These directions include systematic peer teaching and development of anatomy education as a scholarly domain, further vertical integration with postgraduate medical education, full integration with radiology education, and capitalizing on educational technology. Schools in several industrialized countries have made steps in these directions, which can be further strengthened. In less affluent countries, and in countries with curricula strongly determined by tradition, these steps are less easy to make. To respond to changes in global health and health care, combined with the inevitable technological progress, and international mobility, we believe all schools will move in these directions, slower or faster.

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“…Furthermore, it can be seen that any disease process can be considered at two levels. A pathologist may describe the failing internal elements in great detail, typically on a microscopic, histological, or biochemical level [ 21 ]. The clinician meanwhile views the same disease as external failing elements, typically as clinically detectable macroscopic signs and symptoms.…”

Section: Reviewmentioning

confidence: 99%

Diagnosis: Fundamental Principles and Methods

Gale¹

2022

Cureus

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Problem-solving is an essential human endeavor. It involves problem definition, followed by solution design, solution implementation, and, finally, review. Healthcare is a prime and often successful example of problem-solving. In medical terminology, the problem definition is termed the diagnosis, the solution design is called the treatment plan, and the solution itself is the provision of treatment. The case review is used to assess the efficacy of the solution. This process is sequential and consequential. Obviously, if a problem's definition is absent or incorrect, then an appropriate solution cannot be designed or implemented. Unfortunately, missed or incorrect diagnoses are not uncommon in healthcare and can cause considerable harm and economic cost. Minimizing these diagnostic errors would confer great benefits to patients, clinicians, and healthcare organizations. Understanding the nature of diagnosis and why it can be so difficult are some of the first steps in reducing these diagnostic errors. One issue is that diagnosis may seem to be more of an art than a science when the exact mechanisms of diagnosis are often not clearly described. Clinicians typically learn their diagnostic craft by mimicry of their mentors over years of hard experience. This absence of a clear method not only makes diagnosis difficult to do well it also makes diagnosis difficult to teach well. The purpose of this paper is to try to better articulate the fundamental principles and methods of diagnosis and to make diagnosis more intellectually understandable, and so more teachable, and more achievable by clinicians.

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Approaches to Assessing the Clinical Reasoning of Preclinical Students

Cited by 15 publications

References 29 publications

Comparing single-best-answer and very-short-answer questions for the assessment of applied medical knowledge in 20 UK medical schools: Cross-sectional study

Comparing single-best-answer and very-short-answer questions for the assessment of applied medical knowledge in 20 UK medical schools: Cross-sectional study

Are We Facing the End of Gross Anatomy Teaching as We Have Known It for Centuries?

Diagnosis: Fundamental Principles and Methods

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