SHARP (SHort Answer, Rationale Provision): A New Item Format to Assess Clinical Reasoning

Area of Science:

• Medical Education Research
• Assessment Design
• Clinical Reasoning Evaluation

Background:

• Traditional non-workplace assessments often fail to capture crucial problem representation and decision-rationale skills.
• Existing methods for assessing clinical decision-making justification are frequently resource-intensive.

Purpose of the Study:

• To develop and evaluate a scalable, non-workplace-based assessment format to measure learners' ability to justify clinical decisions.
• To introduce the SHARP (Short Answer, Rationale Provision) item format for assessing clinical reasoning.

Main Methods:

• Developed the SHARP (Short Answer, Rationale Provision) item format, integrating short-answer questions with justification of clinical decisions based on patient records.
• Conducted a proof-of-concept study with 177 fourth-year medical students from 20 U.S. medical schools using 35 SHARP items.

Main Results:

• Demonstrated substantial variability in item difficulty, with an average correct response rate of 44%.
• Achieved an estimated reliability of 0.76 (Cronbach α) for the SHARP item set.
• Confirmed that item scoring is fully automated, minimizing resource requirements.

Conclusions:

• The SHARP item format shows potential as a scalable and resource-efficient tool for assessing clinical decision-making justification.
• Further research is planned to gather validity evidence, compare SHARP performance with other exams, and explore formative assessment applications.