Simulation of initial medical problem-solving: a test for the assessment of medical problem-solving.

Abstract

Assessment of medical problem-solving by means of paper and pencil tests has proven to be troublesome. Administering a complete paper-patient encounter takes a lot of time, it is difficult to construct a reliable scoring system, and correlations between cases are consistently low. Research into the nature of medical problem-solving suggests that the just brief period of time after confrontation with a problem is critical. Also a test should consist of a considerable number of different cases. Based on these principals a very simple paper and pencil test was developed call Simulation of Initial Medical Problem-solving (SIMP). The test consists of short case-histories followed by the question: 'What would you do as a physician in this situation?'. The open-ended format is chosen to avoid cueing. The answers are scored with score-models constructed by a panel of experts. Administering this instrument takes about 5–10 minutes per case, so in a 2–hour session a test can contain 20–30 cases. The reliability of the scoring and the validity of the instrument have proven to be satisfactory in previous research.