Do extended matching multiple-choice questions measure clinical reasoning?

Area of Science:

• Medical Education
• Cognitive Science
• Clinical Reasoning Assessment

Background:

• Extended matching questions (EMQs) are a novel examination format.
• EMQs present a clinical case with one correct answer from multiple alternatives.
• This study investigates cognitive differences in problem-solving between medical students and residents using EMQs.

Purpose of the Study:

• To compare the clinical reasoning processes of final-year medical students and internal medicine residents when solving EMQs.
• To determine if expertise influences the approach to diagnostic and pathogenetic problems.
• To evaluate the utility of EMQs in assessing clinical reasoning.

Main Methods:

• Twenty final-year medical students and 20 residents (4th/5th year internal medicine) participated.
• Participants verbally solved 20 EMQs (10 internal medicine, 10 other disciplines) focusing on diagnosis/pathogenesis.
• Sessions were audio-recorded and transcribed for analysis of reasoning processes.

Main Results:

• Residents outperformed students on internal medicine EMQs, employing more forward reasoning.
• No significant difference in performance or reasoning was observed for non-internal medicine EMQs.
• Residents showed a shift towards backward reasoning for non-specialty questions, unlike their approach to internal medicine questions.
• Higher-performing individuals exhibited more forward and less backward reasoning.

Conclusions:

• Medical expertise is characterized by forward reasoning within a specialty.
• Subjects revert to backward reasoning when dealing with topics outside their area of expertise.
• EMQs are a viable tool for assessing and differentiating clinical reasoning processes based on expertise.