The IDEA Assessment Tool: Assessing the Reporting, Diagnostic Reasoning, and Decision-Making Skills Demonstrated in Medical Students' Hospital Admission Notes

Abstract

The IDEA assessment tool is a novel tool with validity evidence to support its use in the assessment of students' reporting, diagnostic reasoning, and decision-making skills. The moderate reliability achieved supports formative or lower stakes summative uses rather than high-stakes summative judgments.

Documentation of Clinical Reasoning in Admission Notes of Hospitalists: Validation of the CRANAPL Assessment Rubric

“…Prior studies have described rubrics for evaluating the clinical reasoning skills of medical students. 14,15 The ICCs for the IDEA rubric used to assess medical students' documentation of clinical reasoning were fair to moderate (0.29-0.67), whereas the ICC for the CRANAPL tool was high at 0.83. This measure of reliability is similar to that for the P-HAPEE rubric used to assess medical students' documentation of pediatric history and physical notes.…”

“…In contrast to CRANAPL, other clinical reasoning rubrics have excluded these items or discussed uncertainty. 14,15,44 These elements represent the forward thinking that may be essential for high-quality progressive care by hospitalists.…”

“…[23][24][25][26] For each of these parties, diagnostic reasoning and its impact on clinical decision-making are considered to be a core competency. Several works that heavily influenced the CRANAPL tool's development were Baker's Interpretive Summary, Differential Diagnosis, Explanation of Reasoning, And Alternatives (IDEA) assessment tool; 14 King's Pediatric History and Physical Exam Evaluation (P-HAPEE) rubric; 15 and three other studies related to diagnostic reasoning. 16,27,28 These manuscripts and other works substantively informed the preliminary behavioral-based anchors that formed the initial foundation for the tool under development.…”

“…However, the sample assessed in our study was significantly larger than that assessed in other studies that have validated clinical reasoning rubrics. 14,15 Fourth, clinical reasoning is a broad and multidimensional construct. The CRANAPL tool focuses exclusively on hospitalists' documentation of clinical reasoning and therefore does not assess aspects of clinical reasoning occurring in the physicians' minds.…”

“…11,12 Studies that have formally evaluated the documentation of clinical reasoning have focused exclusively on medical students. [13][14][15] The nonexistence of a detailed rubric for evaluating clinical reasoning in the A&Ps of hospitalists represents a missed opportunity for evaluating what hospitalists "do"; if this evolves into a mechanism for offering formative feedback, such profes-…”