Advancing the assessment of clinical reasoning across the health professions: Definitional and methodologic recommendations.

David Gordon,Meredith Young,Aliki Thomas,Valerie J Lang,Joseph J Rencic,Steven J Durning

doi:10.1007/s40037-022-00701-3

Abstract

The importance of clinical reasoning in patient care is well-recognized across all health professions. Validity evidence supporting high quality clinical reasoning assessment is essential to ensure health professional schools are graduating learners competent in this domain. However, through the course of a large scoping review, we encountered inconsistent terminology for clinical reasoning and inconsistent reporting of methodology, reflecting a somewhat fractured body of literature on clinical reasoning assessment. These inconsistencies impeded our ability to synthesize across studies and appropriately compare assessment tools. More specifically, we encountered: 1) a wide array of clinical reasoning-like terms that were rarely defined or informed by a conceptual framework, 2) limited details of assessment methodology, and 3) inconsistent reporting of the steps taken to establish validity evidence for clinical reasoning assessments. Consolidating our experience in conducting this review, we provide recommendations on key definitional and methodologic elements to better support the development, description, study, and reporting of clinical reasoning assessments.

Highlights

Clinical reasoning broadly entails the cognitive processes that enable clinicians to observe, collect, and analyze information, resulting in decisions and actions that seek to improve patients’ well-being while considering their specific circumstances and preferences [1, 2]
While we expected the literature on clinical reasoning assessment to be varied, we found its synthesis challenging because: 1) clinical reasoning is a multidimensional construct with varied conceptualizations and definitions, 2) method sections often lacked adequate detail, and 3) there was a paucity of validity evidence supporting a particular clinical reasoning assessment approach
Given that clinical reasoning can be considered a process or outcome, a deeply cognitive or collaborative activity, we recommend that authors describe the theoretical framework(s) that shape how they understand the construct of clinical reasoning, and the perspectives that ground the assessment and study design [34]

Summary

Introduction

Clinical reasoning broadly entails the cognitive processes that enable clinicians to observe, collect, and analyze information, resulting in decisions and actions that seek to improve patients’ well-being while considering their specific circumstances and preferences [1, 2]. Consolidating our experience in conducting this review, we provide recommendations on key definitional and methodologic elements to better support the development, description, study, and reporting of clinical reasoning assessments.

Results

Conclusion