TY  - JOUR
A1  - Kunina-Habenicht, Olga
A1  - Hautz, Wolf E.
A1  - Knigge, Michel
A1  - Spies, Claudia
A1  - Ahlers, Olaf
T1  - Assessing clinical reasoning (ASCLIRE): Instrument development and validation
JF  - Advances in health sciences education : theory and practice
N2  - Clinical reasoning is an essential competency in medical education. This study aimed at developing and validating a test to assess diagnostic accuracy, collected information, and diagnostic decision time in clinical reasoning. A norm-referenced computer-based test for the assessment of clinical reasoning (ASCLIRE) was developed, integrating the entire clinical decision process. In a cross-sectional study participants were asked to choose as many diagnostic measures as they deemed necessary to diagnose the underlying disease of six different cases with acute or sub-acute dyspnea and provide a diagnosis. 283 students and 20 content experts participated. In addition to diagnostic accuracy, respective decision time and number of used relevant diagnostic measures were documented as distinct performance indicators. The empirical structure of the test was investigated using a structural equation modeling approach. Experts showed higher accuracy rates and lower decision times than students. In a cross-sectional comparison, the diagnostic accuracy of students improved with the year of study. Wrong diagnoses provided by our sample were comparable to wrong diagnoses in practice. We found an excellent fit for a model with three latent factors-diagnostic accuracy, decision time, and choice of relevant diagnostic information-with diagnostic accuracy showing no significant correlation with decision time. ASCLIRE considers decision time as an important performance indicator beneath diagnostic accuracy and provides evidence that clinical reasoning is a complex ability comprising diagnostic accuracy, decision time, and choice of relevant diagnostic information as three partly correlated but still distinct aspects.
KW  - Clinical reasoning
KW  - Computer-based assessment
KW  - Diagnostic accuracy
KW  - Medical education
KW  - Validation
KW  - Decision speed
Y1  - 2015
U6  - https://doi.org/10.1007/s10459-015-9596-y
SN  - 1382-4996
SN  - 1573-1677
VL  - 20
IS  - 5
SP  - 1205
EP  - 1224
PB  - Springer
CY  - Dordrecht
ER  -