Diagnostic ability in relation to clinical seminars and extended-matching questions examinations

At the Katholieke Universiteit Leuven, Belgium, final year medical students participate in 70 problem-solving clinical seminars over a period of 2 months, concentrating on clinical reasoning for formulating differential diagnoses. The clinical seminars end in an examination consisting of 200 extended-matching questions (EMQs).

This study asks whether problem-solving clinical seminars improve clinical reasoning and whether the EMQ examination measures clinical decision making. In order to detect an increase in diagnostic ability, the Diagnostic Thinking Inventory (DTI) was applied. The research hypotheses were: (i) DTI scores will be higher after the seminars than before, and (ii) the correlations between DTI scores and EMQ examination scores will be significant.

In the academic year 2003-04, 3 series of problem-solving clinical seminars were held. At the beginning and end of each series the students filled in the DTI. This questionnaire measures 2 aspects of diagnostic thinking: the degree of flexibility in thinking, and how knowledge is structured in the memory.

For all data together, the DTI scores after the clinical seminars were significantly higher than before. Pearson correlations between DTI scores and EMQ examination scores were low but significant, with the exception of post-test Structure (not significant).

Two months of intensive problem-solving clinical training was accompanied by an improvement in diagnostic thinking, as measured by DTI scores. Correlation between DTI scores and examination scores indicates that the EMQs measure an aspect of student achievement that is related to clinical reasoning.