Derakhshandeh Zahra, Amini Mitra, Kojuri Javad, Dehbozorgian Marziyeh
Department of Medical Education, Shiraz University of Medical Sciences, Shiraz, Iran.
Clinical Education Research Center, Shiraz University of Medical Sciences, Shiraz, Iran.
J Adv Med Educ Prof. 2018 Jan;6(1):37-42.
Clinical reasoning is one of the most important skills in the process of training a medical student to become an efficient physician. Assessment of the reasoning skills in a medical school program is important to direct students' learning. One of the tests for measuring the clinical reasoning ability is Clinical Reasoning Problems (CRPs). The major aim of this study is to measure psychometric qualities of CRPs and define correlation between this test and routine MCQ in cardiology department of Shiraz medical school.
This study was a descriptive study conducted on total cardiology residents of Shiraz Medical School. The study population consists of 40 residents in 2014. The routine CRPs and the MCQ tests was designed based on similar objectives and were carried out simultaneously. Reliability, item difficulty, item discrimination, and correlation between each item and the total score of CRPs were all measured by Excel and SPSS software for checking psycometeric CRPs test. Furthermore, we calculated the correlation between CRPs test and MCQ test. The mean differences of CRPs test score between residents' academic year [second, third and fourth year] were also evaluated by Analysis of variances test (One Way ANOVA) using SPSS software (version 20)(α=0.05).
The mean and standard deviation of score in CRPs was 10.19 ±3.39 out of 20; in MCQ, it was 13.15±3.81 out of 20. Item difficulty was in the range of 0.27-0.72; item discrimination was 0.30-0.75 with question No.3 being the exception (that was 0.24). The correlation between each item and the total score of CRP was 0.26-0.87; the correlation between CRPs test and MCQ test was 0.68 (p<0.001). The reliability of the CRPs was 0.72 as calculated by using Cronbach's alpha. The mean score of CRPs was different among residents based on their academic year and this difference was statistically significant (p<0.001).
The results of this present investigation revealed that CRPs could be reliable test for measuring clinical reasoning in residents. It can be included in cardiology residency assessment programs.
临床推理是医学生培训过程中成为高效医生的最重要技能之一。评估医学院课程中的推理技能对于指导学生学习很重要。衡量临床推理能力的测试之一是临床推理问题（CRP）。本研究的主要目的是衡量CRP的心理测量学质量，并确定该测试与设拉子医学院心脏病学系常规多项选择题（MCQ）之间的相关性。
本研究是对设拉子医学院所有心脏病学住院医师进行的描述性研究。研究对象包括2014年的40名住院医师。常规CRP和MCQ测试基于相似目标设计并同时进行。通过Excel和SPSS软件测量可靠性、项目难度、项目区分度以及每个项目与CRP总分之间的相关性，以检查CRP测试的心理测量学特性。此外，我们计算了CRP测试与MCQ测试之间的相关性。还使用SPSS软件（版本20）通过方差分析测试（单因素方差分析）（α = 0.05）评估了住院医师学年[二年级、三年级和四年级]之间CRP测试分数的平均差异。
CRP分数的平均值和标准差在20分中为10.19 ± 3.39；MCQ在20分中为13.15 ± 3.81。项目难度在0.27 - 0.72范围内；项目区分度为0.30 - 0.75，但第3题除外（为0.24）。每个项目与CRP总分之间的相关性为0.26 - 0.87；CRP测试与MCQ测试之间的相关性为0.68（p < 0.001）。使用克朗巴赫α系数计算得出CRP的可靠性为0.72。根据住院医师的学年，CRP的平均分数有所不同，且这种差异具有统计学意义（p < 0.001）。
本次调查结果表明，CRP可以作为衡量住院医师临床推理能力的可靠测试。它可以纳入心脏病学住院医师评估项目中。
