Department of Medicine, Boston University School of Medicine, 72 E. Concord Street, Boston, MA 02118, USA.
Department of Medical Education, Flinders University, Flinders, Australia.
Diagnosis (Berl). 2020 Aug 27;7(3):241-249. doi: 10.1515/dx-2019-0051.
Developing valid assessment approaches to clinical reasoning performance has been challenging. Situated cognition theory posits that cognition (e.g. clinical reasoning) emerges from interactions between the clinician and situational (contextual) factors and recognizes an opportunity to gain deeper insights into clinical reasoning performance and its assessment through the study of these interactions. The authors apply situated cognition theory to develop a conceptual model to better understand the assessment of clinical reasoning. The model highlights how the interactions between six contextual factors, including assessee, patient, rater, and environment, assessment method, and task, can impact the outcomes of clinical reasoning performance assessment. Exploring the impact of these interactions can provide insights into the nature of clinical reasoning and its assessment. Three significant implications of this model are: (1) credible clinical reasoning performance assessment requires broad sampling of learners by expert raters in diverse workplace-based contexts; (2) contextual factors should be more explicitly defined and explored; and (3) non-linear statistical models are at times necessary to reveal the complex interactions that can impact clinical reasoning performance assessment.
开发有效的临床推理绩效评估方法一直具有挑战性。情境认知理论认为，认知（例如临床推理）源自临床医生与情境（上下文）因素之间的相互作用，并通过研究这些相互作用为深入了解临床推理绩效及其评估提供了机会。作者将情境认知理论应用于开发一个概念模型，以更好地理解临床推理的评估。该模型突出了包括评估对象、患者、评估者和环境、评估方法和任务在内的六个情境因素之间的相互作用如何影响临床推理绩效评估的结果。探索这些相互作用的影响可以深入了解临床推理及其评估的本质。该模型有三个重要意义：（1）需要专家评估者在多样化的基于工作场所的情境中广泛评估学习者，以获得可信的临床推理绩效评估；（2）应更明确地定义和探索情境因素；（3）有时需要非线性统计模型来揭示可能影响临床推理绩效评估的复杂相互作用。
