Beullens Johan, Struyf Elke, Van Damme Bo
Centre for Medical Education, Faculty of Medicine, Katholieke Universiteit Leuven, Minderbroederstraat 17, B-3000 Leuven, Belgium.
Med Educ. 2005 Apr;39(4):410-7. doi: 10.1111/j.1365-2929.2005.02089.x.
At the Faculty of Medicine at the Katholieke Universiteit Leuven, Belgium, we have developed a final examination that consists of extended matching multiple-choice questions. Extended matching questions (EMQs) originate from a case and have 1 correct answer within a list of at least 7 alternatives. If EMQs assess clinical reasoning, we can assume there will be a difference between the ways students and experienced doctors solve the problems within the questions. This study compared students' and residents' processes of solving EMQs.
Twenty final year students and 20 fourth or fifth year residents specialising in internal medicine solved 20 EMQs aloud. All questions concerned diagnosis or pathogenesis. Ten EMQs related to internal medicine and 10 questions to other medical disciplines. The session was audio-taped and transcribed.
The residents correctly answered significantly more questions concerning internal medicine than did the students. Their reasoning was more "forward" and less "backward". No difference between residents and students was found for the other questions. The residents scored better on internal medicine than on the other questions. They used more backward and less forward reasoning when solving the other questions than they did with the internal medicine questions. The better half of the respondents used significantly more forward and less backward reasoning than did the poorer half.
In accordance with the literature, medical expertise was characterised by forward reasoning, whereas outside their area of expertise, the subjects switched over to backward reasoning. It is possible to assess processes of clinical reasoning using EMQs.
在比利时鲁汶天主教大学医学院，我们开发了一种期末考试，其由扩展匹配多项选择题组成。扩展匹配题（EMQs）源自一个病例，在至少7个备选答案中有1个正确答案。如果EMQs用于评估临床推理能力，那么我们可以假定学生和有经验的医生解决问题的方式会有所不同。本研究比较了学生和住院医师解决EMQs的过程。
20名医学专业最后一年的学生和20名内科专业四年级或五年级的住院医师大声解答20道EMQs。所有问题均涉及诊断或发病机制。其中10道EMQs与内科相关，另外10道与其他医学学科相关。解答过程进行了录音和转录。
住院医师正确回答的内科相关问题显著多于学生。他们的推理方式更“向前”，而较少“向后”。在其他问题上，未发现住院医师和学生之间存在差异。住院医师在内科问题上的得分高于其他问题。与解决内科问题相比，他们在解决其他问题时使用更多的向后推理，更少的向前推理。前一半受访者比后一半受访者显著更多地使用向前推理，更少地使用向后推理。
与文献一致，医学专业知识的特点是向前推理，而在其专业领域之外，受试者则转向向后推理。使用EMQs可以评估临床推理过程。
