Development and evaluation of clinical reasoning using 'think aloud' approach in pharmacy undergraduates - A mixed-methods study

Twelve tips for applying the think-aloud method to capture cognitive processes

The think-aloud method is an established technique for studying human thought (cognitive) processes. Problem-solving and decision-making are essential skills for medical professionals, and the cognitive processes underlying these skills are complex. Studying these thought processes would enable educators, clinicians, and researchers to modify or refine their approaches and interventions. The think-aloud method has been utilized for capturing cognitive processes in a variety of fields, including computer usability, sports and cognitive psychology. Medical education also recognizes thought processes as valuable data for research and education. This article aims to guide researchers and educators through the preparation and implementation of a think-aloud method to record participants' thought processes during an activity.

Evaluating Clinical Reasoning in Undergraduate Medical Education: The Value of a Virtual Oral Assessment

BACKGROUND

Oral assessments are essential components of board certification in numerous fields, as they provide insight into problem-solving capacity and clinical reasoning. The development of clinical reasoning often begins in undergraduate medical education and remains a challenge to assess.

OBJECTIVE

We developed a pilot oral assessment to evaluate medical student oral presentations and systematically assess clinical reasoning. This was incorporated into a previously existing cumulative assessment at the conclusion of the third year of medical school, with the intent to demonstrate feasibility and future reliability of this exam format.

METHODS

This pilot oral assessment was developed using content taught during third year clerkships. A modified Assessment of Reasoning Tool (ART) was used as the evaluation metric. It was conducted virtually to include faculty members from multiple disciplines and accommodate schedules and space limitations.

RESULTS

A total of 152 third year medical students completed the exam, with a total of 15 faculty examiners. 89% of medical students scored as complete in hypothesis directed history, 93% in problem representation, 86% in prioritized differential diagnoses, and 67% in effectively directing management. Most examiners felt an oral assessment is effective to determine a medical student's clinical reasoning ability.

CONCLUSIONS

Virtual oral assessments of clinical reasoning can be incorporated in undergraduate medical education to identify students struggling with components of clinical reasoning, while also allowing maximum flexibility for the clinician educator workforce as examiners. Longitudinal use of these exams would be valuable to track the development of clinical reasoning across the medical school curriculum.

Clinical reasoning in emergency medical technicians and its compliance with the illness script theory: A pilot study

BACKGROUND

Emergency medical technicians (EMTs) play a pivotal role in the management and treatment chain of emergency patients and their health outcomes. Knowing the clinical reasoning pattern in prehospital procedures is of particular importance that can help to develop a correct clinical decision-making process in this group. Therefore, this study aimed to clarify the clinical reasoning in EMTs and evaluate its compliance with the "illness script" theory.

MATERIALS AND METHODS

This descriptive-analytical study was conducted in 2021 at Hormozgan University of Medical Sciences (HUMS) by involving EMTs in two groups of experts and novices. To collect and analyze participants' mental script-based information, the "think aloud" method was used. In the content analysis of extracted protocols, two main steps were considered: 1) preparing a suitable map to compare the protocol with the base pattern and 2) quantifying the relationship between the protocol and the base pattern. Statistical Package for the Social Sciences (SPSS)-21 software, the Shapiro-Wilk test, and the independent t-test were used for analyzing quantitative data.

RESULTS

After exploring the concordance of the clinical reasoning of EMTs with the base pattern, results showed that the components of Enabling condition and Management were consistent with the illness script strategy. Pathophysiology and Diagnosis components did not conform to the base pattern. Regarding Signs and Symptoms, these were significantly different from the classic pattern of illness script. A new component called Contextual insight was suggested for this pattern. Generally, on comparing the clinical script content of experts and novices, only two components of Pathophysiology and Diagnosis did not show any significant difference (P > 0.05) between these two groups.

CONCLUSION

Results of evaluating the clinical reasoning of the under-study groups showed that in some components of the pattern, they practiced as in other medical groups, but in relation to some components, this was not the case. It is due to the different nature of the prehospital conditions. Also, there is a need to add new components to the base model, which should be considered in distinguishing between expert and novice EMTs.

Encouraging students' engagement and promoting deep learning in immunology through an interactive clinical case problem-solving (CCPS) approach: Perception among cohort of medical students in Oman

BACKGROUND

Modern competency-based medical education emphasizes student-centered teaching-learning strategies where students take responsibility of their own learning. Student-centered approaches facilitate multifaceted learning such as observation, critical evaluation, analysis, deeper understanding, and application of knowledge. The current study aims at assessing the students' perception on utilization of clinical case problem-solving approach (CCPS) to promote their lifelong learning.

MATERIALS AND METHODS

The present cross-sectional study was conducted at College of Medicine and Health Sciences (CoMHS) during the year 2021-2022. MD3 students of the academic year 2021-2022 were the study participants. The study was approved by institutional Ethic and Review Committee. Students' performances were assessed through pre-test and post-test performances. Students' feedback was collected through a predesigned questionnaire on a 3-point Likert scale. Cronbach's alpha coefficient test was used to assess the reliability of the questionnaire. The data was entered to Microsoft Excel and analyzed using SPSS software version 22. Paired t-test was used to compare pre-test and post-test scores and the data was expressed as numbers and percentages.

RESULTS

In total, 103 participants were included in the study. Post-test scores were significantly higher compared to pre-test scores (p < 0.05). Questionnaire results showed that CCPS approach was accepted as an effective learning strategy. Majority (>90%) of the students expressed CCPS approach was interesting, motivated to learn, encouraged peer discussion, enhanced knowledge, and clarified their topic-related doubts. More than 80% students opined that CCPS enhanced their critical thinking, problem-solving ability, deep learning, and lifelong learning skills. Nearly 90% of the students suggested for including such sessions for more topics in immunology course in future.

CONCLUSION

From our study results, it can be concluded that CCPS is an effective learning strategy to encourage students' engagement and promote their deep learning skills.

Development and validation of a script concordance test to assess biosciences clinical reasoning skills: A cross-sectional study of 1st year undergraduate nursing students

BACKGROUND

Developing evaluative measures that assess clinical reasoning remains a major challenge for nursing education. A thorough understanding of biosciences underpins much of nursing practice and is essential to allow nurses to reason effectively. A gap in clinical reasoning can lead to unintended harm. The Script Concordance test holds promise as a measure of clinical reasoning in the context of uncertainty, situations common in nursing practice. The aim of this study is to develop and validate a test for first year undergraduate nursing students that will evaluate how bioscience knowledge is used to clinically reason.

METHODS

An international team, teaching biosciences to undergraduate nurses constructed a test integrating common clinical cases with a series of related test items: diagnostic, investigative and treatment. An expert panel (n = 10) took the test and commented on authenticity/ambiguities/omissions etc. This step is crucial for validity and for scoring of the student test. The test was administered to 47 first year undergraduate nursing students from the author sites. Students rated educational aspects of the tool both quantitatively and qualitatively. Statistical and content analyses inform the findings.

FINDINGS

Results indicate that the test is reliable and valid, differentiating between experts and students. Students demonstrated an ability to identify relevant data, link this to their bioscience content and predict outcomes (mean score = 50.78 ± 8.89). However, they lacked confidence in their answers when the scenarios appeared incomplete to them.

CONCLUSION

Nursing practice is dependent on a thorough understanding of biosciences and the ability to clinically reason. Script concordance tests can be used to promote both competencies. This method of evaluation goes further than probing factual knowledge. It also explores capacities of data interpretation, critical analysis, and clinical reasoning. Evaluating bioscience knowledge and real-world situations encountered in practice is a unique strength of this test.