The assessment of student reasoning in the context of a clinically oriented PBL program

Doctors' clinical reasoning ability significantly impacts upon their level of clinical competence. Throughout medical training students are given the opportunity to develop their reasoning ability in order to become appropriately clinically competent by graduation.

To develop an instrument to assess students' reasoning ability on a written case-based question which was aligned to their learning in a PBL program.

An instrument with 10 criteria centred upon hypothesis generation, learning issues and mechanistic explanations was developed. Experienced clinical and medical educators validated the instrument, prior to its use with 145 undergraduate first-year medical students.

The results enabled the establishment of the strengths and weaknesses in the reasoning performances of individuals, as well as the overall cohort. The instrument's Cronbach alpha coefficient was 0.94, and it had high inter-rater and intra-rater reliability. Further validation of the instrument's performance was established through qualitative evidence derived from student interviews and tutor reports for this cohort.

Aligning written assessment to the PBL process enables students and teachers to better understand how the reasoning process is developing for individuals and a cohort, and provides a basis for further investigation into the development of student clinical reasoning.