Validation of the Quantitative Diagnostic Thinking Inventory for Athletic Training: A Pilot Study

Abstract

Context: The cognitive process of making a clinical decision lies somewhere on a continuum between novices using hypothetico-deductive reasoning and experts relying more on case pattern recognition. Although several methods exist for measuring facets of clinical reasoning in specific situations, none have been experimentally applied, as of yet, to the profession of athletic training. The Diagnostic Thinking Inventory (DTI) has been used with medical doctors and medical students to determine their level of clinical reasoning as it applies to diagnosis making. Objective: To validate the DTI for Athletic Training (DTI-AT) and associated interview questions for use in the field of athletic training. Design: Mixed methodology. Setting: Online inventory and Skype-based interviews. Patients or Other Participants: Convenience sample of 25 senior-level athletic training students. Main Outcome Measure(s): Participants completed an online version of the DTI-AT which rated clinical reasoning tendencies on a 6-point Likert-type scale. Quantitative analysis consisted of determining means and ranges of scores along with reliability of total scores and subset scores. Randomly selected participants were interviewed online in order to provide validity of interview questions that were used to determine personal and professional activities that are either thought to enhance or hinder clinical reasoning. A secondary purpose was to solicit specific feedback that may enhance our understanding of the modified DTI. Results: A strong reliability was found for total DTI (r(41) = 0.846) and an acceptable reliability for flexibility in thinking (r(21) = 0.731) and structure of memory (r(20) = 0.771). Conclusions: The modifications of the DTI-AT demonstrated strong reliability and face validity. The DTI-AT may be an effective tool for determining clinical reasoning of athletic training students.

Using the diagnostic thinking inventory in musculoskeletal physiotherapy: a validity and reliability study

“…In spite of being a cornerstone of musculoskeletal physiotherapy practice, there are limited resources that musculoskeletal physiotherapists can use to self‐assess the advancement of diagnostic reasoning upon participating in continuing education programmes such as those at master's level. Of the many tools and methods to measure diagnostic reasoning in the context of medicine such as clinical reasoning problems (Groves, Scott, & Alexander, 2002) and script concordance test (Lubarsky, Dory, Duggan, Gagnon, & Charlin, 2013), Bordage et al.’s (1990) Diagnostic Thinking Inventory (DTI) stands out as a reliable and valid self‐assessment tool that can be used to assess the perceived advancement in diagnostic reasoning independent of an examiner (Axel Georg Meender, Britta, & Lena, 2019; U. Jones, 1997; Kicklighter, Barnum, Geisler, & Martin, 2016). Since the development of the DTI, it has been extensively used in medical education literature as a tool to evaluate the advancement of clinical reasoning after engagement with specific pedagogies and medical curricula (Beullens, Struyf, & Van Damme, 2006; Gehlhar, Klimke‐Jung, Stosch, & Fischer, 2014; Goss, Reid, Dodds, & McColl, 2011; Groves, 2005; Heinerichs, Vela, & Drouin, 2013; Jerant & Azari, 2004; Lee et al., 2010; Round, 1999; Stieger, Praschinger, Kletter, & Kainberger, 2011; Windish, Price, Clever, Magaziner, & Thomas, 2005).…”

Exploration of Factors Perceived to Influence Development of Diagnostic Reasoning in Athletic Trainers and Athletic Training Students

“…The first interview question was designed to determine participants' understanding of their cognitive processes during a diagnostic encounter. The interviews occurred within 48 hours after each participant completed the recently validated DTI-AT by Kicklighter et al, 18 in which participants encounter a common orthopaedic diagnostic scenario and then are asked to reflect on their diagnostic reasoning over 41 questions, or cues. 18 Our intent was for this metacognitive activity to provide participants with a reference point from which to address our first question with more introspection and personal analysis.…”

“…The interviews occurred within 48 hours after each participant completed the recently validated DTI-AT by Kicklighter et al, 18 in which participants encounter a common orthopaedic diagnostic scenario and then are asked to reflect on their diagnostic reasoning over 41 questions, or cues. 18 Our intent was for this metacognitive activity to provide participants with a reference point from which to address our first question with more introspection and personal analysis. Given that our respondents were then able to make specific comments about their didactic and clinical experiences, to provide specific examples, and to articulate many of the foundational underpinnings of metacognition, reflection, and reasoning found in both practice and the literature, we are confident that our goals were met and that operationally, our methods were effective for addressing our research questions.…”

“…Given these findings, we might cautiously surmise that strategies found in other health care fields to enhance diagnostic reasoning hold the potential to do likewise in athletic training, and therefore can be examined with creative research projects. Further research using quantitative inventories such as the DTI-AT 18 or script concordance tests or mixed methods will be necessary to determine if the enhancers and barriers to diagnostic reasoning development found here have any real effect on diagnostic reasoning development in order for more specific, validated pedagogical tools to be developed.…”

“…The results of the larger study are not presented in this paper. Originally, 103 randomly sampled professional and student participants completed the Diagnostic Thinking Inventory for Athletic Training (DTI-AT) 18 at a site and time of their choosing. Participants were contacted by e-mail within 6 hours after completion of the DTI-AT and asked to participate in an online interview, using either Skype (Microsoft, Redmond, WA) or Apple FaceTime (Cupertino, CA).…”