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Clinical Reasoning Assessment Methods: A Scoping Review and Practical Guidance
Michelle Daniel1, Joseph Rencic, Steven J Durning
1M. Daniel is assistant dean for curriculum and associate professor of emergency medicine and learning health sciences, University of Michigan Medical School, Ann Arbor, Michigan; ORCID: http://orcid.org/0000-0001-8961-7119. J. Rencic is associate program director of the internal medicine residency program and associate professor of medicine, Tufts University School of Medicine, Boston, Massachusetts; ORCID: http://orcid.org/0000-0002-2598-3299. S.J. Durning is director of graduate programs in health professions education and professor of medicine and pathology, Uniformed Services University of the Health Sciences, Bethesda, Maryland. E. Holmboe is senior vice president of milestone development and evaluation, Accreditation Council for Graduate Medical Education, and adjunct professor of medicine, Northwestern Feinberg School of Medicine, Chicago, Illinois; ORCID: http://orcid.org/0000-0003-0108-6021. S.A. Santen is senior associate dean and professor of emergency medicine, Virginia Commonwealth University, Richmond, Virginia; ORCID: http://orcid.org/0000-0002-8327-8002. V. Lang is associate professor of medicine, University of Rochester School of Medicine and Dentistry, Rochester, New York; ORCID: http://orcid.org/0000-0002-2157-7613. T. Ratcliffe is associate professor of medicine, University of Texas Long School of Medicine at San Antonio, San Antonio, Texas. D. Gordon is medical undergraduate education director, associate residency program director of emergency medicine, and associate professor of surgery, Duke University School of Medicine, Durham, North Carolina. B. Heist is clerkship codirector and assistant professor of medicine, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania. S. Lubarsky is assistant professor of neurology, McGill University, and faculty of medicine and core member, McGill Center for Medical Education, Montreal, Quebec, Canada; ORCID: http://orcid.org/0000-0001-5692-1771. C.A. Estrada is staff physician, Birmingham Veterans Affairs Medical Center, and director, Division of General Internal Medicine, and professor of medicine, University of Alabama, Birmingham, Alabama; ORCID: https://orcid.org/0000-0001-6262-7421. T. Ballard is plastic surgeon, Ann Arbor Plastic Surgery, Ann Arbor, Michigan. A.R. Artino Jr is deputy director for graduate programs in health professions education and professor of medicine, preventive medicine, and biometrics pathology, Uniformed Services University of the Health Sciences, Bethesda, Maryland; ORCID: http://orcid.org/0000-0003-2661-7853. A. Sergio Da Silva is senior lecturer in medical education and director of the masters in medical education program, Swansea University Medical School, Swansea, United Kingdom; ORCID: http://orcid.org/0000-0001-7262-0215. T. Cleary is chair, Applied Psychology Department, CUNY Graduate School and University Center, New York, New York, and associate professor of applied and professional psychology, Rutgers University, New Brunswick, New Jersey. J. Stojan is associate professor of internal medicine and pediatrics, University of Michigan Medical School, Ann Arbor, Michigan. L.D. Gruppen is director of the master of health professions education program and professor of learning health sciences, University of Michigan Medical School, Ann Arbor, Michigan; ORCID: http://orcid.org/0000-0002-2107-0126.
Developing clinical reasoning (CR) competence requires effective assessment. This review synthesizes 377 studies on CR assessment methods, categorizing them into workplace-based, simulated, and non-workplace-based approaches to guide best practices.
Area of Science:
- Medical Education
- Healthcare Professional Training
- Assessment Methods
Background:
- Clinical reasoning (CR) competence is crucial for healthcare professionals.
- A wide variety of CR assessment methods exist, posing challenges for selection.
- Evidence synthesis is needed to guide the choice of appropriate CR assessments.
Purpose of the Study:
- To explore the existing range of clinical reasoning assessment methods.
- To synthesize current evidence on CR assessment tools for practice guidance.
Main Methods:
- A comprehensive scoping review was conducted, searching multiple databases.
- PRISMA guidelines were followed, including articles of all study designs evaluating CR assessment.
- Data were extracted and synthesized to summarize each method's characteristics.
Main Results:
- 377 articles were included, categorizing assessments into non-workplace-based, simulated environments, and workplace-based.
- Examples include multiple-choice questions, objective structured clinical examinations, and direct observations.
- Validity, feasibility, advantages, and disadvantages varied significantly across different assessment methods.
Conclusions:
- Numerous assessment methods exist, targeting different facets of clinical reasoning.
- Developing CR competency necessitates comprehensive assessment programs.
- Complementary assessment methods should be used to address individual method limitations.
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