Clinical prioritisation questions: A novel assessment tool to encourage tolerance of uncertainty?

Abstract

Uncertainty is a common and increasingly acknowledged problem in clinical practice. Current single best answer (SBA) style assessments test areas where there is one correct answer, and as the approach to assessment impacts on the approach to learning, these exams may poorly prepare our future doctors to handle uncertainty. We therefore need to modify our approach to assessment to emphasize reasoning and introduce the possibility of more than one 'correct' answer. We have developed clinical prioritisation questions (CPQs), a novel formative assessment tool in which students prioritise possible responses in order of likelihood. This assessment format was piloted with a group of medical students and evaluated in comparison with the more traditional single SBA question format in a team-based learning setting. Students reported that they felt ongoing use would help improve their tolerance of uncertainty (p<0.01). Furthermore, over 80% of students felt that CPQs were more reflective of real-life clinical practice. Group based discussions were significantly longer when answering CPQs (p<0.01), suggesting they may promote richer discourse. CPQs may have a role in formative assessment to help equip students with the skills to cope with ambiguity and strengthen clinical reasoning and decision-making. Institutions may find them more practical to implement compared with other clinical reasoning assessment tools.

Towards a new understanding of uncertainty in medical education

“…Healthcare professionals employ a range of strategies to manage clinical uncertainty, including the use of decision‐making aids such as guidelines and protocols, 63 evidence‐based decision making, 43 clinical decision analysis, 64 and shared decision making 65 . Teaching tools to help medical students navigate uncertainty focus on cognitive and behavioural responses to uncertainty, primarily 66‐74 . Strategies to help medical students acknowledge uncertainty (cognitive response) include clinical simulation training 66 and online clinical vignettes 67 where there is no one correct way of managing a scenario.…”

“…Strategies to help medical students acknowledge uncertainty (cognitive response) include clinical simulation training 66 and online clinical vignettes 67 where there is no one correct way of managing a scenario. Acknowledging the presence of uncertainty in clinical practice has led to the development of examination questions that could replace single best answer questions 68 . Encouraging acknowledgement of uncertainty through self‐reflection with the use of a reflective diary was found to help third‐year medical students express and cope with their uncertainties about clinical practice 69 .…”

Are the doctors of the future ready to support breastfeeding? A cross-sectional study in the UK

“…As there is a clear association between examinations and students' learning, the ABM guidance stresses the additional importance of including breastfeeding in examinations to ensure students dedicate their efforts at learning the relevant material [40,41].…”

Remote online open book exams – students’ view

“…CPQs involve students ranking options, as opposed to selecting one correct answer; they require higher thinking skills and accustom students to clinical uncertainty. 5 Additionally, appropriate infrastructure, including examination software, student devices and technological support, is essential to facilitate the change. For students from lower socioeconomic backgrounds, we feel that universities should subsidise online study subscriptions and provide a private space with reliable internet access if individuals cannot manage at home.…”

“…Novel question types such as CPQs (clinical prioritisation questions) could also be introduced. CPQs involve students ranking options, as opposed to selecting one correct answer; they require higher thinking skills and accustom students to clinical uncertainty 5 . Additionally, appropriate infrastructure, including examination software, student devices and technological support, is essential to facilitate the change.…”