Park Wan Beom, Kang Seok Hoon, Lee Yoon-Seong, Myung Sun Jung
Department of Internal Medicine (WBP), Seoul National University College of Medicine, Seoul, Republic of Korea; Office of Medical Education (SHK, SJM), Seoul National University College of Medicine, Seoul, Republic of Korea; and Department of Forensic Medicine (Y-SL), Seoul National University College of Medicine, Seoul, Republic of Korea.
Am J Med Sci. 2015 Jul;350(1):64-7. doi: 10.1097/MAJ.0000000000000420.
Clinical reasoning ability is an important factor in a physician's competence and thus should be taught and tested in medical schools. Medical schools generally use objective structured clinical examinations (OSCE) to measure the clinical competency of medical students. However, it is unknown whether OSCE can also evaluate clinical reasoning ability. In this study, the authors investigated whether OSCE scores reflected students' clinical reasoning abilities.
Sixty-five fourth-year medical students participated in this study. Medical students completed the OSCE with 4 cases using standardized patients. For assessment of clinical reasoning, students were asked to list differential diagnoses and the findings that were compatible or not compatible with each diagnosis. The OSCE score (score of patient encounter), diagnostic accuracy score, clinical reasoning score, clinical knowledge score and grade point average (GPA) were obtained for each student, and correlation analysis was performed.
Clinical reasoning score was significantly correlated with diagnostic accuracy and GPA (correlation coefficient = 0.258 and 0.380; P = 0.038 and 0.002, respectively) but not with OSCE score or clinical knowledge score (correlation coefficient = 0.137 and 0.242; P = 0.276 and 0.052, respectively). Total OSCE score was not significantly correlated with clinical knowledge test score, clinical reasoning score, diagnostic accuracy score or GPA.
OSCE score from patient encounters did not reflect the clinical reasoning abilities of the medical students in this study. The evaluation of medical students' clinical reasoning abilities through OSCE should be strengthened.
临床推理能力是医生能力的一个重要因素，因此医学院校应该对其进行教学和测试。医学院校通常使用客观结构化临床考试（OSCE）来衡量医学生的临床能力。然而，尚不清楚OSCE是否也能评估临床推理能力。在本研究中，作者调查了OSCE分数是否反映了学生的临床推理能力。
65名四年级医学生参与了本研究。医学生使用标准化病人完成了包含4个病例的OSCE。为了评估临床推理，要求学生列出鉴别诊断以及与每个诊断相符或不相符的发现。获取了每名学生的OSCE分数（接诊分数）、诊断准确性分数、临床推理分数、临床知识分数和平均绩点（GPA），并进行了相关性分析。
临床推理分数与诊断准确性和GPA显著相关（相关系数分别为0.258和0.380；P分别为0.038和0.002），但与OSCE分数或临床知识分数无关（相关系数分别为0.137和0.242；P分别为0.276和0.052）。OSCE总分与临床知识测试分数、临床推理分数、诊断准确性分数或GPA均无显著相关性。
本研究中来自接诊的OSCE分数并未反映医学生的临床推理能力。应加强通过OSCE对医学生临床推理能力的评估。
