The Development and Pilot Testing of a Community-Practice, Clinical Pharmacy Decision-Making Assessment Instrument

The development and pilot testing of a computerized, simulation-based instrument, designed to analyze the community-practice, clinical decision-making skills of seniorpharmacy students, is described. Four communitypractice clinical scenarios were simulated. A microcomputer unobtrusively collected information-searching data and the decisions made. The instrument's purpose was to describe decision-making processes in order to understand these and eventually improve instruction in this area. The reliability of the instrument was assessed as acceptable. Content validity was assured during development and confirmed through a panel of clinical judges, pharmacy practitioners, and pilot-test students. Construct validity was demonstrated, whereas concurrent validity was only partially evidenced. From preliminary observations, it appeared that expert practitioners took longer and occasionally accessed more information than did students when making clinical decisions. This instrument has potential value as a teaching and diagnostic tool in pharmacy decision making.

Medical student use of history and physical information in diagnostic reasoning

Clinical data gathering is central to clinical competence. Although research has demonstrated the value to experienced clinicians of information obtained from the history, little is known of how medical students use this information. In the present study, two case simulations (in rheumatoid arthritis and systemic lupus erythematosis) were developed to assess medical student information gathering and utilization. The results indicate that most of the students were already considering the correct diagnosis as a possibility after the presenting complaint and patient description. However, the medical history exerted the strongest influence on transforming the correct diagnosis from just another diagnostic possibility into the favored diagnostic candidate. Students who failed to list the correct diagnosis in the differential diagnosis after obtaining the history were significantly less likely to reach the correct diagnosis at the end of the case. These results confirm the critical importance of the history in medical problem solving.