Twelve tips for developing key-feature questions (KFQ) for effective assessment of clinical reasoning

Clinical reasoning is the cognitive process that makes it possible for us to reach conclusions from clinical data. "A key feature (KF) is defined as a significant step in the resolution of a clinical problem. Examinations using key-feature questions (KFQs) focus on a challenging aspect in the diagnosis and management of a clinical problem where the candidates are most likely to make errors." KFs have been used at different levels of medical education and practice, from undergraduate to certification examinations. KFQs illuminate the strengths and limits of an individual's clinical problem-solving ability. These types of items are more likely than other forms of assessment to discriminate among stronger or weaker candidates in the area of clinical reasoning. The 12 tips in this article will provide guidance to faculty who wish to develop KFQs for their tests.