Clinical reasoning is a cornerstone of effective clinical practice. Recently, competency frameworks have emphasized that clinicians must learn to reason in contexts of ambiguity, and not just in routine cases. While work has begun on teaching approaches, the role of assessment in influencing the development of this competency has to our knowledge not been explored. While assessment is typically used to capture levels of performance, a growing body of literature suggests assessment can also serve as an educational intervention – shaping, supporting and encouraging (or discouraging) learning. Here, we examine how different assessment approaches may influence future clinical reasoning performance.
The objective of this study is to examine how testing format (single-best MCQ-based or open-ended) influences later performance on a clinical reasoning task.
We propose a two-phase multiple-methods study. The experimental study (Phase 1) will examine whether completing different assessment formats will influence how learners reason in later ambiguous cases, specifically their range of interpretations of an ambiguous symptom, and their tendency to consider multiple diagnoses. Participants will:
1) Review peer-generated cases (priming phase).
2) Test their knowledge with either MCQ or open-ended assessments (2-arm intervention phase).
3) Diagnose clinical cases (diagnostic phase).
4) Assign symptoms to particular diagnostic categories (symptom identification phase).
We hypothesize that participants exposed to open-ended questions will be more likely to report multiple interpretations of ambiguous symptoms and identify more than one diagnosis than those exposed to MCQs. Participants will be invited to participate in a qualitative descriptive study (Phase 2) with semi-structured interviews intended to elicit their views on the relationship between assessment approach and their clinical reasoning.
Disentangling the intended and unintended educational impact of assessments will contribute to more intentionally designed assessment programs to support the development of clinical reasoning.