Cheng Kuan-Hao, Lee Chi-Yu, Wu Yih-Jer, Lin Ching-Chung
Department of Internal Medicine, MacKay Memorial Hospital, Taipei, Taiwan.
Department of Medicine, MacKay Medical College, New Taipei City, Taiwan.
J Med Educ Curric Dev. 2024 Sep 16;11:23821205241280946. doi: 10.1177/23821205241280946. eCollection 2024 Jan-Dec.
It is crucial that teaching faculties determine and remain informed of medical school learners' clinical reasoning competence. We created an innovative assessment method for fourth-year medical students to identify deficiencies in various components of their clinical reasoning ability.
This was a cross-sectional observational study of fourth-year medical students' reasoning assessments from 2019 to 2022. Teams of four-five trainees questioned standardized patients in clinical scenarios, including fever, abdominal pain, and weight loss. They then individually documented key information to reflect comprehension of patient problems. Trainees were tasked with differentiating diagnoses and associated statuses and reaching the most likely diagnosis along with two tentative diagnoses. The correlations observed between 2020 and 2022 for abdominal pain were analyzed using student -tests.
A total of 177 students participated in this study. Across the scenarios, there was no significant difference in key information representation scores (56%-58%). Reasoning ability scores were 49% for fever, 57% for abdominal pain, and 61% for weight loss. A comparison between 2020 and 2022 revealed a significant improvement in the objective structured clinical examination scores and differential diagnoses (< .01). Shortcomings included brief chief complaint duration, lack of detailed presentation, and insufficient description of negative information. Differential diagnosis and diagnostic justification were inadequate for acute and chronic conditions, and disease location clarity within the organ system was lacking. On average, students presented two correct diagnoses.
Fourth-year medical students exhibited inadequate reasoning abilities, particularly in fever and abdominal pain scenarios, with deficiencies in hypothesis generation and differential diagnosis. Group history-taking with individual reasoning assessment identified students' shortcomings and provided faculty feedback to improve their teaching strategies.
教学人员确定并及时了解医学院学生的临床推理能力至关重要。我们为四年级医学生创建了一种创新的评估方法，以识别他们临床推理能力各个组成部分的不足。
这是一项对2019年至2022年四年级医学生推理评估的横断面观察性研究。由四五名受训人员组成的小组在包括发热、腹痛和体重减轻等临床场景中询问标准化病人。然后他们分别记录关键信息以反映对患者问题的理解。受训人员的任务是区分诊断和相关状况，并得出最可能的诊断以及两个暂定诊断。使用学生t检验分析了2020年至2022年期间观察到的腹痛相关性。
共有177名学生参与了本研究。在所有场景中，关键信息呈现得分（56%-58%）没有显著差异。推理能力得分在发热方面为49%，腹痛方面为57%，体重减轻方面为61%。2020年与2022年的比较显示，客观结构化临床考试成绩和鉴别诊断有显著提高（<0.01）。不足之处包括主诉持续时间短、缺乏详细描述以及对阴性信息的描述不足。急性和慢性疾病的鉴别诊断和诊断依据不足，器官系统内疾病位置清晰度不够。平均而言，学生们提出了两个正确的诊断。
四年级医学生表现出推理能力不足，尤其是在发热和腹痛场景中，在假设生成和鉴别诊断方面存在缺陷。小组病史采集与个人推理评估相结合，识别出了学生的不足之处，并为教师提供了反馈，以改进他们的教学策略。
