Knowledge, realism, and diagnostic reasoning in a physical diagnosis course

Two 20-item tests and a case problem were administered to 83 students in a physical diagnosis course. One test contained items related to the content of the case problem, and the other items related to the balance of the course content. Confidence scoring procedures yielded scores of both knowledge and realism on the two tests. The case problem determined the subject's ability to integrate clinical data into an accurate list of diagnoses and yielded scores reflecting incomplete assembly of clues into diagnoses (incomplete synthesis) and unjustified conclusions (premature closure). Reliability of the confidence-scored tests was significantly greater than the reliability on the same items scored as a single correct answer. Knowledge improvement scores on both tests (relevant and nonrelevant knowledge) were significantly correlated with errors of incomplete synthesis. The realism score correlated significantly with premature closures but only on the test where the item content was relevant to the case problem.