Development of Clinical Reasoning Exercises in a Problem-Based Curriculum

The paper describes an approach to assessing clinical reasoning through the use of multiple short cases in an oral or written examination format. Two studies were performed in consecutive medical school curricular units. The first evaluation exercise tested understanding of pathophysiological mechanisms using both oral and written cases. This study demonstrated acceptable test reliability and a high correlation between written and oral formats. A second study emphasised clinical diagnostic reasoning and examined generalizability across cases, body-systems and occasions (test-retest). This study used the oral format alone, with the same students but a different set of tutors from those participating in the first study. In the second study, a moderate correlation with performance on a concurrent multiple choice test and an Observed Structured Clinical Exam (OSCE) was observed.