Clinical Reasoning Competence Research Articles

Effects of Handover Education Using the Outcome-Present State Test (OPT) Model and SBAR in Nursing Students: A Quasi-Experimental Design.

Since most of nursing students lack clinical reasoning competency, for effective handover education, it is necessary to include a strategy to improve the clinical reasoning competency in the practical training course of the nursing department. This study used a quasi-experimental research design using a non-equivalent control group pretestposttest design to verify the effectiveness of the practice education program using the OPT model and SBAR. The subjects were 73 third-year students participating in clinical practice or clinical alternative practice in Korea. The experimental group showed significantly better communication clarity (t=-12.262, P<.001), communication confidence (t=-12.486, P<.001), problem-solving processes (t=-13.100, P<.001), and team efficacy (t=-6.197, P<.001) compared to before the intervention. However, there was no significant difference between the pre- and post-intervention scores of the control group. In a situation where clinical practice is difficult for nursing students, the handover education program using the OPT model and SBAR can helps improve their communication clarity, communication confidence, problem-solving process, and team efficacy.

Using virtual reality in a blended learning course of clinical reasoning competency in primary care: a case study in Central Vietnam

Using virtual reality in a blended learning course of clinical reasoning competency in primary care: a case study in Central Vietnam

Development of the clinical reasoning competency scale for nurses

BackgroundClinical reasoning is emphasized as an important component of nursing education, since nurses’ lack of clinical reasoning leads to incorrect clinical decision-making. Therefore, a tool for measuring clinical reasoning competency needs to be developed.MethodsThis methodological study was conducted to develop the Clinical Reasoning Competency Scale (CRCS) and examine its psychometric properties. The attributes and preliminary items of the CRCS were developed based on a systematic literature review and in-depth interviews. The validity and reliability of the scale were evaluated among nurses.ResultsThe exploratory factor analysis was conducted for the construct validation. The total explained variance of the CRCS was 52.62%. The CRCS consists of 8 items for plan setting, 11 items for intervention strategy regulation, and 3 items for self-instruction. The Cronbach’s α of the CRCS was 0.92. Criterion validity was verified with the Nurse Clinical Reasoning Competence (NCRC). The correlation between the total NCRC and CRCS scores was 0.78, all of which were significant correlations.ConclusionThe CRCS is expected to provide raw scientific and empirical data for various intervention programs to develop and improve nurses’ clinical reasoning competency.

통합시뮬레이션 교육이 간호대학생의 간호지식, 임상수행능력 및 임상추론역량에 미치는 효과

Objectives This study aimed to identify the effect of Integrated simulation(virtual reality simulation with high-fidelity simulation) education on nursing students’ knowledge, clinical performance, and clinical reasoning competency. A single group pre-post quasi-experimental design was used. Methods Data were collected from November 2021 to December 2021. Nursing knowledge, clinical performance ability, and clinical reasoning competency scores were analyzed from the learning evaluation data of 67 students before and after the integrated simulation class. Data were analyzed by Wilcoxon signed rank test using IBM SPSS 23.0 since the normality test was not satisfied. Results The results indicated that the group that participated in the integrated simulation education program had significantly higher nursing knowledge (z=6.201, p&lt;.001), clinical performance (z=4.999, p&lt;.001) and clinical reasoning competency (z=6.616, p&lt;.001) compared to the pre-test. Conclusions The results of this study can be used as basic data for developing educational programs that can enhance existing simulation classes and improve nursing knowledge, clinical performance, and clinical reasoning capabilities.

Effects of a Nursing Simulation Learning Module on Clinical Reasoning Competence, Clinical Competence, Performance Confidence, and Anxiety in COVID-19 Patient-Care for Nursing Students

This study aimed to develop a nursing simulation learning module for coronavirus disease 2019 (COVID-19) patient-care and examine its effects on clinical reasoning competence, clinical competence, performance confidence, and anxiety in COVID-19 patient care for nursing students. A non-equivalent control group pre- and post-test design was employed. The study participants included 47 nursing students (23 in the experimental group and 24 in the control group) from G City. A simulation learning module for COVID-19 patient-care was developed based on the Jeffries simulation model. The module consisted of a briefing, simulation practice, and debriefing. The effects of the simulation module were measured using clinical reasoning competence, clinical competence, performance confidence, and anxiety in COVID-19 patient-care. Data were analyzed using χ²-test, Fisher's exact test, t-test, Wilcoxon signed-rank test, and Mann-Whitney U test. The levels of clinical reasoning competence, clinical competence, and performance confidence of the experimental group were significantly higher than that of the control group, and the level of anxiety was significantly low after simulation learning. The nursing simulation learning module for COVID-19 patient-care is more effective than the traditional method in terms of improving students' clinical reasoning competence, clinical competence, and performance confidence, and reducing their anxiety. The module is expected to be useful for educational and clinical environments as an effective teaching and learning strategy to empower nursing competency and contribute to nursing education and clinical changes.

A simulation-based OSCE with case presentation and remote rating - development of a prototype.

Simulation-based examination formats improve the possibility to assess medical students' competences during their performance. Additionally, videotaping of simulations allows for remote rating, providing advantages for raters, students, and exam organizers. We describe a simulation-based OSCE prototype with remote rating of students' competences, developed to replace a conventional OSCE at Hamburg Medical Faculty. The assessment consists of two phases: a consultation phase with four simulated patient encounters and a case presentation phase where four students present two cases each. All encounters from the consultation and the presentation phase are to be videotaped and remotely rated by clinical raters. Advanced medical students (year 4) are to be assessed regarding their clinical knowledge as well as physician-patient-communication, clinical reasoning competence, and patient management competence. We provide detailed schedules for the simulation-based OSCE procedure and a roster for organization. When piloting the assessment, we encountered two major obstacles with respect to legal obligations regarding examination time and videotaping which allowed us to provide tips on how to successfully implement this assessment prototype. Remote rating will, when successfully implemented, help students to concentrate on their consultation or presentation tasks, reduce raters' time constraints and also allow for randomized rating. Using established instruments for competence-rating rather than OSCE checklists provides an additional feature for this simulation-based OSCE prototype. Legal issues can be avoided by using the prototype for formative assessment but should be addressed in advance when it is planned to be used as summative assessment.

Percepção sobre o desenvolvimento da competência "raciocínio clínico" por graduandos de curso de medicina

Abstract: Introduction: The way by which physicians process clinical reasoning is a relevant topic in the discussions on medical education because, in medical activity, the ultimate goal is to obtain the correct diagnosis and conduct. The challenge is to highlight which factors influence this performance. Objective: The objective of this study is to understand how the development of the clinical reasoning competence occurs according to the medical students’ perception. Method: This research has a descriptive focus and employs a qualitative approach in the ordering of data, classification process, and final analysis of information from 36 semi-structured interviews with medical students, from July to September 2020, in Curitiba, Paraná, Brazil. Result: Thematic analysis was carried out, and the category ‘perception of the factors that influence its achievement’ emerged, with the ‘methodological and curricular structure’ subcategories perceived as the main influencing factors, through characteristics such as interdisciplinarity, early interaction with practical activities, stimulus to autonomy and teaching guidance. Participation in monitoring, academic leagues and extension projects were also considered, as well as the experience of the process of learning appropriation. Conclusion: The present study addresses the topic of clinical reasoning and brings as a contribution the analysis of the factors that influence its development, during undergraduate school, based on the students’ viewpoint. Its results bring benefits to medical education, as they expand the understanding of the process of developing the clinical reasoning competence.

Learning Model to Achieve Clinical Reasoning Competency Using Technology-Enhanced Learning in Neurology Clinical Rotation: An Exploratory Study

The COVID-19 pandemic has necessitated major adaptations in learning activities related to developing clinical reasoning competencies in neurology clerkship. The application of technology in this context is promising, but there are also several limitations. This study explores a learning model for achieving clinical reasoning competency using technology-enhanced learning in neurology clinical rotation. The study used a case-study design and was conducted at the Faculty of Medicine of YARSI University and its two teaching hospitals. Data were collected by document analysis, three focus group discussions with eight medical students and 20 postgraduate medical students, and five in-depth interviews with five neurologists. All the transcribed data were analysed with thematic analysis using the Steps for Coding and Theorization (SCAT) approach. Two themes were revealed—contributing factors and learning strategies—and six factors were found to influence the learning model: the quantity and quality of teacher interactions, students’ motivation and skills in learning and technology, the variety and number of patients in teaching hospitals, the quality and quantity of facilities and infrastructure for service and education at the teaching hospitals, the clinical rotation programme design, and learning adaptation during the pandemic. The following technology-enhanced learning strategies for developing clinical reasoning skills were identified: blended learning, online logbook, telemedicine, collaborative online learning between teaching hospitals, and learning videos. This learning model can be implemented in a limited resource setting. Importantly, the identified factors from the perspective of students, clinical teachers, and school of medicine/teaching hospital, as well as technical factors, should be considered for the implementation of this model.

Translation and Validation of the Persian Version of the Nurses Clinical Reasoning Scale (NCRS): A Psychometric Analysis

Purpose Nurses need strong clinical reasoning competency because they provide specialized and important care to patients. It is hence necessary to measure nurses’ clinical reasoning by using a valid and reliable tool. Objective This study aimed to translate and determine the psychometric test of Persian version of the nurses clinical reasoning scale. Methodology This study was a cross-sectional study. In the first step of this methodological study, the English version of Nurses Clinical Reasoning Scale (NCRS) was translated and back-translated. Then the content validity index (CVI) of the items was assessed based on expert views, and its face validity was examined by studying the views of the target group and experts. In the next step, 170 nurses working in hospitals affiliated with Tabriz University of Medical Sciences were asked to complete the instrument. Finally, the construct validity and reliability of this scale were measured using exploratory factor analysis (EFA) and internal consistency (Cronbach’s alpha), respectively. Results The findings showed that the CVI values of all the items were greater than .8. The wording of some items was changed based on the suggestions received regarding face validity, whereas the results of content and face validity did not necessitate the elimination of any of the items. The EFA results also suggested that the Persian version of the NCRS had a two-factor structure with the titles of nursing diagnosis and care knowledge. The Cronbach’s alpha for this scale was 0.91, which confirmed its internal consistency. Conclusion This instrument is valid and reliable enough to assess Iranian nurses’ clinical reasoning in the dimensions of nursing diagnosis and care knowledge. The research limitations and further recommendations will be discussed later in this paper.

Effects of Elaboration and Instructor Feedback on Retention of Clinical Reasoning Competence Among Undergraduate Medical Students

This randomized crossover trial examines whether elaboration on common errors in patient treatment, combined with individualized mailed feedback, improves medium-term retention of clinical reasoning competence.

Co-design: a guided reflective learning conversation model for simulation-based education

The critical care environment is stressful with complex clinical cases and high levels of workload [1]. Adequate exposure to various clinical experiences is essential to develop effective clinical reasoning skills [2]. Taking into consideration the risk of clinical practice mistakes and the importance of patient safety, simulation is an effective method to immerse learners in scenarios that mimic clinical situations with focused learning opportunities. Guided reflection through reflective learning conversations following simulation activities is recognized as an effective method to develop clinical reasoning skills [3]. We describe a co-design process to develop a simulation guided reflective learning conversation model to optimize the clinical reasoning skills for critical care nurses attending simulation-based activities. A co-design working group of 10 critical care nurses of varying levels of seniority, experience, nationality, and gender; two critical care doctors; three patient representatives; 2 researchers, and 5–6 critical care educators are working collaboratively to co-design the guided reflective learning conversation model, in which clinical reasoning can be optimized with consideration to a wide range of case complexity, subspecialty, and competence levels. The co-design working group is meeting online for 4–6 workshops of 4 hours. The co-design process is built on valid and reliable clinical reasoning and educational theoretical frameworks and models. The inputs to the process, exercises, and activities are taking place during the workshops and the outputs of the workshops are described to establish the co-design process. The final draft of the model will be validated and tested. The study sample will be grouped into experimental and control cohorts of critical care nurses who attend critical care simulation-based courses (N=300). Data will be collected through surveys, focus groups, and simulation-based objective assessment and observations. The study has received Institutional Review Board approval from the Hamad Medical Corporation Medical Research Centre (MRC-01-22-117) and the University of Hertfordshire (HSK/PGR/UH/04728). The first draft of the co-design model is presented in Simulation-Based Reflective Learning Conversation Model (SBRLCM) under development Clinical reasoning is multidimensional with difficulty to structure and evaluate during debriefing. Developing a guided reflective learning conversation model in which clinical reasoning skills are actively and effectively embedded, would therefore enable critical care nurses developing clinical reasoning skills to meet the special demands of critical care. 1. Vahedian-Azimi A, Hajiesmaeili M, Kangasniemi M, Fornés-Vives J, Hunsucker RL, Rahimibashar F, Pourhoseingholi MA, Farrokhvar L, Miller AC. Effects of stress on critical care nurses: a national cross-sectional study. Journal of intensive care medicine. 2019;34(4):311–22. 2. Kang H, Kang HY. The effects of simulation-based education on the clinical reasoning competence, clinical competence, and educational satisfaction. Journal of the Korea Academia-Industrial cooperation Society. 2020;21(8):107–14. 3. Decker S, Alinier G, Crawford SB, Gordon RM, Jenkins D, Wilson C. Healthcare Simulation Standards of Best Practice

Effectiveness of e-STORY App in clinical reasoning competency and self-directed learning among students in associate nursing program: A quasi experimental study

AimThe purpose of this study was to promote students’ clinical reasoning (CR) and self-directed learning (SDL). The specific aims were: (1) to examine effectiveness of the e-STORY App in promoting nursing students’ CR and SDL; and (2) to explore the relationships between levels of learning motivation and suitability of the e-STORY App. BackgroundCR and SDL are core competencies for nursing students. However, new graduates tend to be in adequately prepared in these competencies. Humanoid diagram uses diagrams to guide students in gaining a comprehensive view of the patient issues, which may promote attainment of these competencies. The Z generation students favor learning through smart devices for the feature of no time and spatial limitations. The e-STORY App was developed to overcome the setbacks of creating hard-copy drawings to promote learning effectiveness. DesignThis quasi-experimental study used two-group repeated measure design with a convenience sample. MethodsA total of 77 students from two sections of the “Seminar for Clinical Case Studies” course participated in the study (experimental group: 39 students; control group: 38 students). Data were collected before, one week after and four weeks after the teaching intervention. The instruments used were demographic information sheet, Huang et al.’s (in press) Clinical reasoning scale and Cheng et al. (2010) Self-directed learning instrument. ResultsThere were no significant differences in the CR and SDL scores between the experimental and control groups one week after the intervention (p＞.05). Analyses of the delay effects four weeks after the intervention found significantly higher CR scores in the experimental group than the control group (p < .05). However, there were no significant differences in the SDL scores between groups (p＞.05). Analysis of the findings from the experimental group found that students with moderate and low learning motivation showed significantly higher CR scores on the posttest and follow-up test (p < .05). ConclusionsApplication of the e-STORY App as a supplementary teaching strategy promoted nursing students’ CR ability, especially in students with moderate or low learning motivation. It is recommended to use the App in students with moderate or low learning motivation to promote learning effectiveness.

Assessing clinical reasoning ability in fourth-year medical students via an integrative group history-taking with an individual reasoning activity

BackgroundThe most important factor in evaluating a physician’s competence is strong clinical reasoning ability, leading to correct principal diagnoses. The process of clinical reasoning includes history taking, physical examinations, validating medical records, and determining a final diagnosis. In this study, we designed a teaching activity to evaluate the clinical reasoning competence of fourth-year medical students.MethodsWe created five patient scenarios for our standardized patients, including hemoptysis, abdominal pain, fever, anemia, and chest pain. A group history-taking with individual reasoning principles was implemented to teach and evaluate students’ abilities to take histories, document key information, and arrive at the most likely diagnosis. Residents were trained to act as teachers, and a post-study questionnaire was employed to evaluate the students’ satisfaction with the training activity.ResultsA total of 76 students, five teachers, and five standardized patients participated in this clinical reasoning training activity. The average history-taking score was 64%, the average key information number was 7, the average diagnosis number was 1.1, and the average correct diagnosis rate was 38%. Standardized patients presenting with abdominal pain (8.3%) and anemia (18.2%) had the lowest diagnosis rates. The scenario of anemia presented the most difficult challenge for students in history taking (3.5/5) and clinical reasoning (3.5/5). The abdominal pain scenario yielded even worse results (history taking: 2.9/5 and clinical reasoning 2.7/5). We found a correlation in the clinical reasoning process between the correct and incorrect most likely diagnosis groups (group history-taking score, p = 0.045; key information number, p = 0.009 and diagnosis number, p = 0.004). The post-study questionnaire results indicated significant satisfaction with the teaching program (4.7/5) and the quality of teacher feedback (4.9/5).ConclusionsWe concluded that the clinical reasoning skills of fourth-year medical students benefited from this training course, and the lower correction of the most likely diagnosis rate found with abdominal pain, anemia, and fever might be due to a system-based teaching modules in fourth-year medical students; cross-system remedial reasoning auxiliary training is recommended for fourth-year medical students in the future.

Factors affecting triage competence among emergency room nurses: A cross-sectional study.

The purpose of this study was to examine work-related stress, nurse-physician collaboration and clinical reasoning competence to identify the factors that affected the triage competence of emergency room nurses. A quick and accurate treatment plan for patients is first determined by a triage nurse. Triage competence is an indispensable requirement for emergency room nurses. A cross-sectional design was adopted. The participants comprised 156 emergency room nurses in South Korea who had more than 1 year of experience working in an emergency room. The collected data were analysed using SPSS 28.0. Self-reported data were collected via the Korean Nursing Stress, Nurse-Physician Collaboration, Nurse Clinical Reasoning, Emergency Room Nurse Triage Competence assessing work-related stress, nurse-physician collaboration, clinical reasoning competence and triage competence. In the analyses, multiple regression analysis using the enter method was conducted. We have followed through the STROBE checklist for the preparation of this manuscript. Triage competence significantly differed according to the age (F=9.93, p < .001), clinical experience (F=18.82, p < .001), emergency department experience (F=12.07, p < .001), triage experience (t=4.40, p < .001) and if nurses had a triage certificate (t=4.85, p < .001). The factors that influenced triage competence included clinical reasoning competence (β=.36, p < .001), emergency department experience (β=.21, p=.006), work-related stress (β=.18, p=.007) and nurse-physician collaboration (β=-.17, p=.009); these factors accounted for 38.1% of the variance in triage competence. The results of this study show that efforts to improve triage competence should be based on clinical reasoning. In addition, an effective plan should be devised to improve nurse-physician collaboration and work-related stress. Education programmes should be developed to enhance clinical reasoning competence in order to improve triage competence. In addition, a method for managing work-related stress among nurses in emergency departments and programmes to enhance collaborative physician-nurse relations should be developed.

Development of Critical Reflection Competency Scale for Clinical Nurses.

Critical reflection develops nurses’ critical thinking and clinical reasoning competency. It is necessary to develop a validated scale to measure critical reflection competency considering the clinical situation and nursing context. Therefore, this study analyzed the concept of critical reflection, developed a scale to measure critical reflection competency, and verified its validity and reliability. The concept of critical reflection and components of the scale were confirmed through literature review and results of previous studies on content analysis. A total of 64 preliminary items were derived on a 5-point Likert scale. The adequacy of vocabulary and expression was checked, and a content validity test was conducted. An I-CVI value of 0.88–1.00 was computed. Construct validity was conducted through an exploratory factor analysis, and data collected from 296 clinical nurses were analyzed. Five factors and nineteen items were derived, and the explanatory power was found to be 53.02%. Cronbach’s α of the scale was 0.853. Future studies need to develop a critical reflection education program and utilize this concept as an educational strategy. We propose a study to verify the effect of applying an educational program using the critical reflection competency scale developed in this study.

표준화 환자를 적용한 정신장애 이상행동 관련 웹 기반 동영상 프로그램 개발 및 효과

Purpose: This study aimed to develop a web-based video program related to abnormal mental disorder behaviors in standardized patients and verify its effectiveness for nursing students. Methods: This study consisted of pre-test and post-test for a non-equivalent control group design. The participants were 46 nursing students(experimental group: 23, control group: 23). The experimental group was trained in a video program that applied standardized patients, while the control group received traditional training. Data collected from March to June, 2020, were analyzed using IBM SPSS Statistics for Windows, version 25.0, chi-square test, Fisher's exact test, Mann-Whitney U test, and independent t-test. Results: The difference between the experimental and control groups was statistically significant in terms of learning satisfaction (Z=2.08, p=.038), learning self-efficacy(t=2.80, p=.009), motivation for transfer(t=3.45, p=.001), and clinical reasoning competence(t=2.28, p=.028). Conclusion: This study showed that a video program on abnormal mental disorder behaviors in standardized patients is an effective tool for mental health nursing education.

A Cross-Sectional Study: What Contributes to Nursing Students' Clinical Reasoning Competence?

Clinical reasoning is a vital competence for nursing students, as it is required for solving problems arising in complex clinical situations. Identifying the factors that influence nursing students’ clinical reasoning competence in the social context can help their implicit educational needs. Therefore, this study aimed to determine the factors associated with developing clinical reasoning competency among undergraduate nursing students. In total, 206 senior nursing students were included in this study. Self-reported measures were used to obtain data on participants’ clinical reasoning competence, problem-solving abilities, academic self-efficacy, and level of clinical practicum stress. Relationships among continuous variables were analyzed using Pearson’s correlation coefficients. A multiple linear regression analysis was conducted to identify factors related to clinical reasoning competence. Our findings show that participants with better problem-solving abilities and academic self-efficacy perceived themselves as having higher levels of clinical reasoning competence. Nursing students with lower clinical practicum stress reported higher clinical reasoning competence. Significant factors identified were younger age and subcategories of problem-solving ability such as problem clarification, alternative solution development, planning/implementation, and self-regulated efficacy. Our findings highlight essential factors necessary for developing a nursing curriculum that contributes to professional nurses’ clinical reasoning competence.

Effects of Handoff Education using Concept Mapping and PASS-BAR

Purpose: The purpose of this study was to identify effects of Handoff Education using Concept mapping and PASS-BAR (HECPAR) on clinical reasoning competence, self-efficacy for handoff, and handoff performance of new nurses.Methods: Participants were randomly allocated into an experimental group (n=20) and control group (n=21). The experimental group received HECPAR which consisted of a one hour lecture, case based clinical practicum, and mentoring for a week. The control group received the usual informal handoffs education from senior nurses. Clinical reasoning competence, self-efficacy for handoff, and handoff performance were measured before and a week after HECPAR. Data were analyzed using Mann-Whitney U test, independent t-test, Fisher’s exact test, and chi-sqaure test. Results: The experimental group showed significant improvement in clinical reasoning competence (z=-2.29, p=.022), handoff performance (z=-2.23, p=.026), and self-efficacy of handoff (t=3.47, p=.001) compared to the control group.Conclusion: The results indicate that HECPAR is effective in improving clinical reasoning competence, self-efficacy for handoff, and handoff performance by new nurses. In addition, integrating concept mapping, PASS-BAR, and mentoring proved beneficial for handoff education for new nurses.

Development and Application of Case-based Video Education for Oncology Nursing based on Clinical Reasoning

Purpose: The purposes of this study were to develop a case-based video education program for oncology nursing based on clinical reasoning and to identify the clinical reasoning competence and satisfaction with the education of students in an oncology advanced practice nursing program after applying the video education. Methods: This study was a single group before and after designed experiment for identifying the clinical reasoning competence and satisfaction with education after a case-based video education program for oncology nursing based on clinical reasoning. Eight experts developed a case-based video education program based on clinical reasoning. Fifty-seven students from an oncology advanced practice nursing program participated in this education format. The clinical reasoning competence and satisfaction with education were measured with online self-reporting questionnaires. Results: The overall education satisfaction was 4.21±0.67 points (out of 5). The clinical reasoning competence increased from 55.25±6.54 points to 61.18±7.13 points (out of 75) after completing the education program and there was a statistically significant difference (t=-6.52, p＜.001). Conclusion: The case-based video education for oncology nursing based on clinical reasoning was effective in improving the students’ clinical reasoning competence. Various education programs should be developed and applied to improve the clinical reasoning competence of students in an oncology advanced practice nursing program.

Using script concordance tests for assessing clinical reasoning skills of medical students

The clinical reasoning competency has been identified as one of the core competencies, which is expected to be attained by an undergraduate medical student. It is difficult to assess the clinical reasoning skills in a standardized manner using the available existing tests. To address these gaps and to ensure standardization of the assessments, a script concordance test (SCT) has been designed and implemented in the field of medical education to assess different domains. The test is designed in such a way that it indicates the manner in which a doctor in authentic settings organizes their knowledge and attempts to solve the problem using clinical reasoning skills. In conclusion, the SCT in the field of medical education can be employed to assess clinical reasoning skills and the ability of the student to interpret the given findings under the clouds of uncertainty. Moreover, owing to the relative ease to create, administer, and score and because of better psychometric indices, each of the medical colleges should explore its possibility and implement it within their settings as a tool for teaching and assessment.