A practical guide to assessing clinical decision-making skills using the key features approach

Traditional methods for evaluating clinical decision-making often lack consistency and reliability. Prior research has shown that patient management problems (PMPs) are limited in their ability to capture essential decision-making steps. This gap motivated the development of alternative formats like key features problems (KFPs). Educators have long sought tools that can more accurately reflect real-world clinical reasoning. KFPs aim to address this limitation by focusing on critical decision points. The shift from PMPs to KFPs reflects a broader trend toward more structured and valid assessment methods. However, no prior work had resolved the specific steps for creating KFPs. This paper fills that gap by offering a practical guide.

The goal of this paper is to provide a detailed framework for writing key features problems (KFPs). These problems are designed to assess clinical decision-making in a structured way. The authors aim to clarify the process for educators and assessors. They emphasize the importance of identifying critical decision points in clinical scenarios. This approach allows for more accurate and reliable evaluations. The paper also seeks to highlight the advantages of KFPs over older formats like PMPs. By offering a step-by-step guide, the authors hope to improve the consistency of assessments. This guide supports educators in creating valid and reliable clinical decision-making tests.

The authors outline a structured process for developing key features problems (KFPs). The first step involves forming a group of problem writers. These groups are responsible for selecting appropriate clinical scenarios. Next, they define the key features within each scenario. The next phase involves crafting questions that target these key features. Response formats are chosen to match the nature of the clinical decisions being tested. Scoring keys are then prepared to ensure consistent evaluation. Item quality is reviewed to maintain reliability and validity. Finally, items are stored in a database for future use.

The KFP format offers a flexible and reliable method for assessing clinical decision-making. Key features are identified as critical decision points in a clinical scenario. Questions are designed to test these features directly. The use of scoring keys ensures consistent evaluation across different assessors. The paper provides examples of how to structure these questions and responses. Item quality is maintained through rigorous review processes. When constructed according to the guidelines, KFPs demonstrate strong validity and reliability. These results suggest that KFPs are a valuable tool for educators.

The authors conclude that KFPs offer a practical and reliable alternative to older assessment formats. They emphasize the importance of following a structured process when developing these problems. The use of key features ensures that assessments focus on essential clinical decisions. The paper provides clear steps for assembling writing groups and defining key features. Scoring keys and item quality reviews are highlighted as essential components. The authors suggest that KFPs can be adapted to various clinical settings. These findings support the use of KFPs in medical education. The paper provides a foundation for educators to implement these assessments effectively.