临床推理评估方法：范围综述与实践指导。

Clinical Reasoning Assessment Methods: A Scoping Review and Practical Guidance.

机构信息

M. Daniel is assistant dean for curriculum and associate professor of emergency medicine and learning health sciences, University of Michigan Medical School, Ann Arbor, Michigan; ORCID: http://orcid.org/0000-0001-8961-7119. J. Rencic is associate program director of the internal medicine residency program and associate professor of medicine, Tufts University School of Medicine, Boston, Massachusetts; ORCID: http://orcid.org/0000-0002-2598-3299. S.J. Durning is director of graduate programs in health professions education and professor of medicine and pathology, Uniformed Services University of the Health Sciences, Bethesda, Maryland. E. Holmboe is senior vice president of milestone development and evaluation, Accreditation Council for Graduate Medical Education, and adjunct professor of medicine, Northwestern Feinberg School of Medicine, Chicago, Illinois; ORCID: http://orcid.org/0000-0003-0108-6021. S.A. Santen is senior associate dean and professor of emergency medicine, Virginia Commonwealth University, Richmond, Virginia; ORCID: http://orcid.org/0000-0002-8327-8002. V. Lang is associate professor of medicine, University of Rochester School of Medicine and Dentistry, Rochester, New York; ORCID: http://orcid.org/0000-0002-2157-7613. T. Ratcliffe is associate professor of medicine, University of Texas Long School of Medicine at San Antonio, San Antonio, Texas. D. Gordon is medical undergraduate education director, associate residency program director of emergency medicine, and associate professor of surgery, Duke University School of Medicine, Durham, North Carolina. B. Heist is clerkship codirector and assistant professor of medicine, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania. S. Lubarsky is assistant professor of neurology, McGill University, and faculty of medicine and core member, McGill Center for Medical Education, Montreal, Quebec, Canada; ORCID: http://orcid.org/0000-0001-5692-1771. C.A. Estrada is staff physician, Birmingham Veterans Affairs Medical Center, and director, Division of General Internal Medicine, and professor of medicine, University of Alabama, Birmingham, Alabama; ORCID: https://orcid.org/0000-0001-6262-7421. T. Ballard is plastic surgeon, Ann Arbor Plastic Surgery, Ann Arbor, Michigan. A.R. Artino Jr is deputy director for graduate programs in health professions education and professor of medicine, preventive medicine, and biometrics pathology, Uniformed Services University of the Health Sciences, Bethesda, Maryland; ORCID: http://orcid.org/0000-0003-2661-7853. A. Sergio Da Silva is senior lecturer in medical education and director of the masters in medical education program, Swansea University Medical School, Swansea, United Kingdom; ORCID: http://orcid.org/0000-0001-7262-0215. T. Cleary is chair, Applied Psychology Department, CUNY Graduate School and University Center, New York, New York, and associate professor of applied and professional psychology, Rutgers University, New Brunswick, New Jersey. J. Stojan is associate professor of internal medicine and pediatrics, University of Michigan Medical School, Ann Arbor, Michigan. L.D. Gruppen is director of the master of health professions education program and professor of learning health sciences, University of Michigan Medical School, Ann Arbor, Michigan; ORCID: http://orcid.org/0000-0002-2107-0126.

出版信息

Acad Med. 2019 Jun;94(6):902-912. doi: 10.1097/ACM.0000000000002618.

DOI:10.1097/ACM.0000000000002618

PMID:30720527

Abstract

PURPOSE

An evidence-based approach to assessment is critical for ensuring the development of clinical reasoning (CR) competence. The wide array of CR assessment methods creates challenges for selecting assessments fit for the purpose; thus, a synthesis of the current evidence is needed to guide practice. A scoping review was performed to explore the existing menu of CR assessments.

METHOD

Multiple databases were searched from their inception to 2016 following PRISMA guidelines. Articles of all study design types were included if they studied a CR assessment method. The articles were sorted by assessment methods and reviewed by pairs of authors. Extracted data were used to construct descriptive appendixes, summarizing each method, including common stimuli, response formats, scoring, typical uses, validity considerations, feasibility issues, advantages, and disadvantages.

RESULTS

A total of 377 articles were included in the final synthesis. The articles broadly fell into three categories: non-workplace-based assessments (e.g., multiple-choice questions, extended matching questions, key feature examinations, script concordance tests); assessments in simulated clinical environments (objective structured clinical examinations and technology-enhanced simulation); and workplace-based assessments (e.g., direct observations, global assessments, oral case presentations, written notes). Validity considerations, feasibility issues, advantages, and disadvantages differed by method.

CONCLUSIONS

There are numerous assessment methods that align with different components of the complex construct of CR. Ensuring competency requires the development of programs of assessment that address all components of CR. Such programs are ideally constructed of complementary assessment methods to account for each method's validity and feasibility issues, advantages, and disadvantages.

摘要

目的

为了确保临床推理（CR）能力的发展，基于证据的评估方法至关重要。CR 评估方法的多样性给选择适合目的的评估方法带来了挑战；因此，需要对现有证据进行综合，以指导实践。进行了范围综述，以探索现有的 CR 评估菜单。

方法

根据 PRISMA 指南，从多个数据库中搜索了从成立到 2016 年的所有文章。如果研究了 CR 评估方法，则纳入所有研究设计类型的文章。文章按评估方法进行分类，并由两位作者进行审查。提取的数据用于构建描述性附录，总结每种方法，包括常见的刺激物、反应格式、评分、典型用途、有效性考虑因素、可行性问题、优点和缺点。

结果

共有 377 篇文章最终被纳入综合分析。这些文章大致分为三类：非工作场所评估（例如，多项选择题、扩展匹配题、关键特征考试、脚本一致性测试）；模拟临床环境中的评估（客观结构化临床考试和技术增强模拟）；以及工作场所评估（例如，直接观察、全面评估、口头病例报告、书面记录）。方法不同，有效性考虑因素、可行性问题、优点和缺点也不同。