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Assessing clinical reasoning (ASCLIRE): Instrument development and validation.

Olga Kunina-Habenicht1, Wolf E Hautz2,3, Michel Knigge4,5

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|March 2, 2015
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Summary

This study developed the ASCLIRE test to measure clinical reasoning, finding it involves distinct skills like diagnostic accuracy and decision time. Experts outperformed students, showing improved accuracy with study progression.

Keywords:
Clinical reasoningComputer-based assessmentDecision speedDiagnostic accuracyMedical educationValidation

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Area of Science:

  • Medical Education
  • Cognitive Science

Background:

  • Clinical reasoning is a core medical competency.
  • Assessing clinical reasoning requires evaluating multiple facets of the decision-making process.

Purpose of the Study:

  • To develop and validate a computer-based test (ASCLIRE) for assessing clinical reasoning.
  • To evaluate diagnostic accuracy, information collection, and decision time.

Main Methods:

  • A norm-referenced computer-based test (ASCLIRE) was developed.
  • 283 students and 20 experts diagnosed six clinical cases.
  • Structural equation modeling analyzed test structure and performance indicators.

Main Results:

  • Experts demonstrated superior diagnostic accuracy and faster decision times compared to students.
  • Student diagnostic accuracy correlated positively with their year of study.
  • A three-factor model (accuracy, time, information choice) showed good fit, with accuracy and time being distinct.

Conclusions:

  • ASCLIRE effectively assesses clinical reasoning as a multifaceted ability.
  • Diagnostic accuracy and decision time are key, partly independent, performance indicators.
  • The test provides valuable insights into medical decision-making processes.