Diagnostic Thinking Inventory Research Articles

Clinical reasoning skills of German and Dutch manual therapists: a cross-sectional study

ABSTRACT Introduction Reflective clinical reasoning (CR) is believed to play a crucial role in achieving an efficient therapy process, supported by evidence-based approaches that improve patient outcomes. The aim of this study was to evaluate the CR process of German manual therapists (MTs) using the CR skills of Dutch MTs as a reference. Methods This cross-sectional study evaluated the CR process and diagnostic ability of German MTs. Dutch MTs served as the reference standard due to their experience with direct access. The CR skills were assessed using the Diagnostic Thinking Inventory (DTI), a questionnaire measuring diagnostic competence. Descriptive and inferential statistics were conducted to compare the groups. Subgroup analyses were performed to analyze the influence of work experience (in years) and the level of education on CR. Results 396 manual therapists (229 German and 167 Dutch) completed the DTI. Dutch MTs revealed higher DTI sum-scores compared to German MTs (p < .001; Cohen´s d = .41). Subgroup analyses regarding professional education revealed no significant differences in DTI sum-scores within German MTs and between both groups. In the subgroup analyses regarding professional experience, differences of moderate effect size were reached between German and Dutch novice MTs (in favor of Dutch novice MTs; p = .001; Cohen´s d = .62), and between German novice MTs and experienced German MTs (in favor of experienced German MTs; p < .001; Cohen´s d = .6). Conclusion The results suggest that academically educated German and Dutch MTs as well as experienced German and Dutch MTs are similar in terms of their hypothetical-deductive CR skills. In turn, German novice MTs seem to use hypothetical-deductive processing to a lesser extent compared to Dutch novice MTs and experienced German MTs, which in turn may support the hypothesis that the level of professional experience and education has a significant impact on the development of hypothetical-deductive CR skills.

Validating the Korean shorter Diagnostic Thinking Inventory in medical education: a pilot study.

Developing clinical reasoning across the medical curriculum requires valid, reliable, and feasible assessment tools. However, few validated tools are available for the convenient and efficient quantification of clinical reasoning. Thus, this study aimed to create a shorter version of the Diagnostic Thinking Inventory (DTI) and validate it in the Korean medical education context (DTI-SK). The DTI-SK was constructed using content validity and a translation and back-translation process. It comprises two subcategories and 14 items. Its validity and reliability were explored using exploratory and confirmatory factor analyses, mean comparisons of four medical student groups (med 1 to med 4), and internal consistency using Cronbach's α. Two hundred medical students were invited to participate through email, and the survey was administered for 2 weeks. Data from 136 students were analyzed. Exploratory factor analysis revealed two factors with eigenvalues greater than 1.0 and they together explained 54.65% of the variance. Confirmatory factor analysis demonstrated that the model had acceptable level of fit and convergent validity. Discriminant validity was confirmed using heterotrait-monotrait criterion. Group comparisons demonstrated that the med 4 students showed significantly higher scores than the med 1 and 2 students. The inventory exhibited strong internal consistency for all items (Cronbach's α=0.906). The findings indicated that the DTI-SK is a reliable and valid tool for measuring medical students' clinical reasoning in the context of Korean medical education.

Evaluation Of Development Of Clinical Reasoning Skills In Dental Students Through Diagnostic Thinking Inventory.

To assessthe clinical reasoning skills among dentalstudents, and to compare the diagnostic thinking ability of male and female students. The cross-sectionalstudy was conducted from May to July 2021 at a public-sector dental school in Karachi, and comprised students of both genders from across allthe four years ofdentalschool.Datawas collectedusing thediagnostic thinking inventory which also assessed flexibility in thinking and knowledge structure inmemory.Datawas analysedusing SPSS 18. Of the 111 forms distributed, 108(98.2%) were received duly filled; 32 (29.35%) from male students and 76(69.72) from female students. Participants from the first year were 24(22%), second year 23(21%), third year 33 (30.27%) and the fourth year 29(26.6%).The reliability of diagnostic thinking inventory was 0.906, for knowledge structure in memory 0.661, andflexibility inthinking0.573.The correlationwassignificantforstudentsintheir 2nd, 3rdand4thyearsofstudies(p=0.01) The overall mean score was <150 which was poor. Both the knowledge structure in memory, and flexibility in thinking scores were higher for females compared to males(Significant at the level of 0.01). The clinical reasoning skills of students were low, and the diagnostic thinking ability of female students was better than that of their male counterparts.

An international comparison of student nurse practitioner diagnostic reasoning skills.

Nurse practitioners (NPs) play a pivotal role in health care provision. Diagnostic reasoning is an important core skill of advanced practice. The purpose of this study was to compare diagnostic reasoning skills of NP students. It also identified the variability in clinical teaching components of a sample of international NP curricula. An international group of NP students completed an online survey using a validated diagnostic reasoning scale during the first year of their NP program. Program faculty surveyed provided data on core curricula. The NP students' (n = 152) mean diagnostic thinking inventory (DTI) score was 142, flexibility in thinking subscale score mean of 73 with a knowledge structure in memory of 69. The programs surveyed required bioscience courses. Most programs provided opportunities for students to practice diagnostic thinking using individual precepted clinical hours (range 500-950) and objective structured clinical examinations. The lower scores of this group of NP students were similar to other NP students and first-year medical residents. Higher mean scores in the DTI reflect expertise and are developed over time. Courses providing a foundation of biomedical knowledge were identified in each program, with opportunities for the NP students to practice diagnostic thinking using objective structured clinical examinations and clinical practice hours. The use of the diagnostic reasoning inventory is a useful tool for evaluating student NP's diagnostic reasoning during their NP program. Nurse practitioner programs should consider the provision of dedicated clinical hours, including supervised clinical practice experiences and objective structured clinical examinations to improve diagnostic reasoning.

Promoting medical student’s clinical reasoning during COVID-19 pandemic

Purpose: The development of students’ clinical reasoning skills should be a consideration in the design of instruction and evaluation in medical education. In response to the coronavirus disease 2019 (COVID-19) pandemic, several changes in the medical curriculum have been implemented in promoting clinical reasoning. This study aims to explore medical students’ perceptions and experiences with the clinical reasoning curriculum during the COVID-19 pandemic and determine their skills development.Methods: The study used a mixed-method design with a concurrent approach. A cross-sectional study was conducted to compare and examine the relationship between the outcomes of the structured oral examination (SOE) and the Diagnostic Thinking Inventory (DTI). Then, the qualitative method was used. A focus group discussion using a semi-structured interview guide with open-ended questions was conducted, then the verbatim transcript was subjected to thematic analysis.Results: There is an increase in SOE and DTI scores between second-year to fourth-year students. The diagnostic thinking domains and SOE are significantly correlated (r=0.302, 0.313, and 0.241 with p&lt;0.05). The three primary themes from the qualitative analysis are perceptions regarding clinical reasoning, clinical reasoning activities, and the learning component.Conclusion: Even if students are still studying throughout the COVID-19 pandemic, their clinical reasoning skills can improve. The clinical reasoning and diagnostic thinking skills of medical students increase as the length of the school year increases. Online case-based learning and assessment support the development of clinical reasoning skills. The skills are supported in their development by positive attitudes toward faculty, peers, case type, and prior knowledge.

Longitudinal clinical reasoning theme embedded across four years of a medical school curriculum.

The acquisition of clinical reasoning (CR) skills is essential for future healthcare providers as they advance through their education. There is growing consensus that CR skills should be longitudinally integrated into undergraduate curriculum for acquisition/application of these skills. However, only a minority of schools reported having CR focused teaching sessions, citing a lack of curricular time and faculty expertise as the largest barriers. We describe thedesign and implementation of this theme and report the effects of its early introduction in Phase One as measured by the Diagnostic Thinking Inventory (DTI). The Carver College of Medicine developed and implemented a longitudinal four-year clinical reasoning theme (CRT) with a special emphasis on introducing concepts in the preclinical years (Phase One). Educational strategies used to implement the theme relied on following principles: 1) new skills are best acquired in context ofapplication; 2) contextual learning stimulates transfer ofknowledge; and 3) knowledge of pathophysiology is necessary but alone is not sufficient to develop CR skills. Apatient-centered CR schema served as the framework for developing the theme. Specific focus areas, pedagogies and assessment strategies were established for each of the three phases. The cohort with CRT demonstrated a significant increase in total DTI score after theme implementation compared to the cohort without. A formal 4-year longitudinal CR theme is feasible, allowing for integration of pathophysiology, social determinants of health, and clinical skills. Early introduction of CR concepts as assessed by DTI showed improvement in student reasoning skills post-intervention.

CRITICAL THINKING, CLINICAL REASONING SKILLS AND COGNITIVE ABILITIES OF DENTAL STUDENTS

Background: Critical thinking (CT) and clinical reasoning (CR), along with adequate clinical knowledge, are crucial components of thinking in clinical practice. This study aimed to assess, compare and analyze the relationship between CT skills, CR skills, and cognitive abilities in undergraduate (UDS) and clinical dental students (CDS).Methods: This natural experimental study was conducted using the quantitative descriptive-analytic methods with a cross-sectional design. Thirty UDS and sixty-one CDS were selected purposively. Demographic and academic data were obtained through questionnaires. The Critical Thinking Tool (CriTT) was used to measure CT skills, and CR skills were measured by the Diagnostic Thinking Inventory (DTI). Knowledge acquisition was measured through the Cognitive Ability Test (CAT), which is a set of multiple-choice questions specifically developed and validated for this study. The statistical differences between them were analyzed by one-way ANOVA, and their relationship was tested by correlation matrix analyses.Results: There were no differences in CriTT measurements between groups. The overall DTI score and subscale 2 (Structure of memory) showed significant differences between groups, as did the overall CAT score and all clinical science subscales. Correlation matrix analyses revealed CR skills were related to CT skills, while the cognitive abilities or knowledge acquisition were related to CR skills.Conclusion: Results showed the CR skills and cognitive abilities of clinical dental students are superior to undergraduate dental students. Generally, the results indicated the more skilled students are in critical thinking, the better are their clinical reasoning skills. Better cognitive abilities tended to improve clinical reasoning skills.

Clinical reasoning skills of medical students, Faculty of Medicine Alzaiem Alazhari University Khartoum Sudan Measured by Diagnostic Thinking Inventory (DTI)

Clinical reasoning skills of medical students, Faculty of Medicine Alzaiem Alazhari University Khartoum Sudan Measured by Diagnostic Thinking Inventory (DTI)

Using the diagnostic thinking inventory in musculoskeletal physiotherapy: a validity and reliability study.

Development of clinical reasoning is an essential aspect in musculoskeletal physiotherapy practice that is linked to better outcomes. The measurement of clinical reasoning has placed an emphasis on diagnostic reasoning using different types of examinations. The Diagnostic Thinking Inventory (DTI) is a self-assessment tool developed to measure two aspects of diagnostic reasoning: flexibility in thinking (FT) and structure in memory (SM). DTI is valid and reliable that has been used extensively in medical field. To investigate the validity and reliability of DTI in musculoskeletal physiotherapy practice. Two groups of musculoskeletal physiotherapists completed DTI. Expert musculoskeletal physiotherapists assessed face and content validity. Data from the second group of musculoskeletal physiotherapists were used to assess test-retest reliability. Internal consistency was calculated using Cronbach's alpha. Construct validity was assessed by comparing both groups. Data were analyzed using the IBM SPSS statistics 25.0 version. The experts agreed that DTI measures diagnostic reasoning. For test-retest reliability, average intraclass correlation coefficient was 0.91, 0.92 and 0.90 (p<0.001) for DTI, FT and SM scores, respectively. Cronbach's alpha was 0.909, 0.919 and 0.897 (p<0.001) for DTI, FT and SM, respectively. The independent samples t-test demonstrated that the experts group achieved higher and statistically significant score (p<0.001). DTI is valid and reliable in measuring diagnostic reasoning in the context of musculoskeletal physiotherapy practice. It can be used to assess the impact of continuing education on musculoskeletal physiotherapists' diagnostic reasoning.

Evaluation of the reliability of diagnostic thinking inventory for physical therapist and of the development of clinical reasoning in physiotherapy students

Background Several instruments have been developed to assess clinical reasoning ability, regardless of specific knowledge. One of these instruments is the Diagnostic Thinking Inventory (DTI), used by doctors and medical students to determine their level of diagnostic clinical reasoning as it applies to the diagnosis. Objective The purposes of the pilot study were three-fold: (1) to assess internal consistency after adapting the DTI to the context of physical therapy (DTI-PT), (2) to assess the association between diagnostic clinical reasoning, self-assessment of clinical reasoning ability, and academic performance among physiotherapy students; and (3) to compare diagnostic clinical reasoning, self-assessment of clinical reasoning ability, and academic performance in the beginning and the end of the semester. Method A total of 40 physiotherapy students were assessed for the association of student performance, student clinical competence and DTI-PT between the beginning of August and the end of November 2017 in the discipline of assessment in physiotherapy. Results The results showed an improvement in the DTI-PT score and its sub-scales at the end of the semester. There was an improvement in the student clinical competence and in the students' performance score. Conclusion DTI-PT can be an effective tool to determine the clinical reasoning of physiotherapy students.

The Feasibility Test of “COVID” Learning Strategy: An Alternative Approach to Cope Learning Process during Pandemic of COVID-19

Introduction: The COVID-19 outbreak requires spread prevention strategies that affects the education system at all levels. Consequently, appropriate and relevant learning strategies are required. The study aimed to examine the feasibility of “COVID” learning strategy as an alternative online learning system during pandemic COVID-19. Methods: The study applied a pre-experimental design with a one-group pretest-posttest approach. The sample size (34 participants) was determined using G*Power 3.1.9.7 software. The open recruitment of the participants was announced through WhatsApp. Students who were willing to be the participants were asked to fulfill the enrollment link. As the intervention, nursing students were taught using the "COVID (Creative, Outcomes-oriented, Valuable, Innovative, and Desire)" learning strategy. Two variables i.e. critical thinking and learning environment satisfaction were measured using the Diagnostic Thinking Inventory (DTI) and the Dundee Ready Education Environment Measure (DREEM), respectively. The paired t-test was used to analyze the DTI and DREEM data before and after the intervention. Results: The results show that the Flexibility Thinking dimension of DTI was significant with t-value of (30) = 7.025, p = .000. Likewise, with the assessment of the learning atmosphere using DREEM, a significant result was obtained with t (33) = -457,263, p = .000. The respondents' satisfaction with the "COVID" learning strategy was 8.5 on average. Conclusion: The "COVID" learning strategy can improve flexible thinking and student satisfaction with the online learning process. The "COVID" learning strategy can be an alternative learning strategy that is effective in the online learning process.

Increasing Neonatal Healthcare Productivity using Clinical Reasoning Coaching Tools

Introduction: Productivity in medical field has inherent value in terms of improving our lives, which can expand our economies. Productivity in medicine has many aspects including improving clinical diagnostic skills, safety, and quality and quantity care. This study will assess whether early exposure to structured clinical reasoning coaching tools would improve their clinical decision making and productivity. Research question: Does clinical reasoning coaching tools Increase neonatal healthcare productivity? Materials and method: Medical practitioners recently joined neonatal units will participate over 2 years in an innovative series of clinical reasoning coaching sessions blended with virtual patients. Practitioners will be exposed to many teaching methods during the neonatal training that includes lectures, bedside teaching sessions and small group discussions beside website continuous contact for learning and chairing skills. Teaching series scope should cover resuscitating sick neonates, handling ventilators either conventional or high frequency, practicing common neonatal procedures, dealing with common neonatal scenarios, infection control policy and, effective communication skills The evaluation sessions will be introduced at the beginning of their training, during the course and at the end of the clerkship to assess their improving productivity, using diagnostic thinking inventory(DTI). Selection of the medical practitioners will be based on either on stratified random sampling or cohort control depending on the funding and logistic. All items will be analysed advanced statistical analysis methods. Results: The coaching tool may yield dramatic impact, allowing the innovators to be more productive. Suggesting widely utilize it for nurses, undergraduate and postgraduate medical Subspecialty. Conclusion: The research hypothesis is assuming that DTI scores and productivity will be higher after the coaching sessions as rated by the candidate’s performance.

Embedding a longitudinal diagnostic reasoning curriculum in a residency program using a bolus/booster approach.

Background Diagnostic reasoning skills are essential to the practice of medicine, yet longitudinal curricula to teach residents and evaluate performance in this area is lacking. We describe a longitudinal diagnostic reasoning curriculum implemented in a university-based internal medicine residency program and self-evaluation assessment of the curriculum's effectiveness. Methods A longitudinal diagnostic reasoning curriculum (bolus/booster) was developed and implemented in the fall of 2015 at the University of Iowa. R1, R2, and R3 cohorts were taught the "bolus" curriculum at the beginning of each academic year followed by a "booster" component to maintain and build upon diagnostic reasoning skills taught during the "bolus" phase. Self-administered diagnostic thinking inventory (DTI) scores were collected in the spring of pre-curriculum (baseline, 2014-2015) and post-curriculum (2016-2017). Results The overall DTI scores improved in the R1 cohort, although statistically significant differences were not seen with R2s and R3s. In the original DTI categories, R1s improved in both flexibility of thinking and structure of thinking, the R2s improved in structure of thinking and the R3s did not improve in either category. R1s showed improvement in three of the four subcategories - data acquisition, problem representation, and hypothesis generation. The R2s improved in the subcategory of problem representation. R3s showed no improvement in any of the subcategories. The R3 cohort had higher mean scores in all categories but this did not reach statistical significance. Conclusions Our program created and successfully implemented a longitudinal diagnostic reasoning curriculum. DTI scores improved after implementation of a new diagnostic reasoning curriculum, particularly in R1 cohort.

Theory-guided teaching: Implementation of a clinical reasoning curriculum in residents

Introduction: Educators have theorized that interventions grounded in dual process theory (DPT) and script theory (ST) may improve the diagnostic reasoning process of physicians but little empirical evidence exists.Methods: In this quasi-experimental study, we assessed the impact of a clinical reasoning (CR) curriculum grounded in DPT and ST on medicine residents participating in one of three groups during a 6-month period: no, partial, or full intervention. Residents completed the diagnostic thinking inventory (DTI) at baseline and 6 months. At 6 months, participants also completed a post-survey assessing application of concepts to cases.Results: There was a significant difference between groups in application of concepts (no intervention 1.6 (0.65) compared to partial 2.3 (0.81) and full 2.2 (0.91), p = 0.05), as well as describing cases in problem representation format (no intervention 1.2 (0.38) and partial 1.5 (0.55) compared to full 2.1 (0.93), p = 0.004). There was no significant difference in change in DTI scores (no intervention 7.0 (16.3), partial 8.8 (9.8), full 7.8 (12.0)).Conclusions: Residents who participated in a CR curriculum grounded in DPT and ST were effective in applying principles of CR in cases from their practice. To our knowledge, this is the first workplace-based CR educational intervention study showing differences in the reasoning process residents apply to patients.

Cultural adaption and validation of the German version of the diagnostic thinking inventory (DTI-G) / Ein Instrument zur Erhebung diagnostischer Kompetenz: Validierung und kulturelle Adaptation des Diagnostic Thinking Inventory (DTI-G)

Abstract Diagnostic ability is essential for expert professional practice. Several instruments have been developed to assess diagnostic skills independent of specific knowledge. One such instrument is the diagnostic thinking inventory (DTI), which is used in different settings to evaluate diagnostic performance and has shown acceptable reliability and validity. The aim of the present study was to translate and validate a German version (DTI-G). Cultural adaptation and translation were performed according to international guidelines. Internal consistency and item discrimination indexes were calculated. The factorial structure of the DTI-G, test-retest reliability and known-groups validity were tested. A total of 388 physiotherapists completed the questionnaire. The internal consistency was good for the overall score of the DTI-G (Cronbach’s a = 0.84). Exploratory factor analysis yielded a five-factor solution with 21 items that explained 55% of the total variance across items. A confirmatory principal component analysis resulted in the same five-factor structure, showing an acceptable to good overall fit of the model (CFI = 0.93; RMSEA = 0.05; SRMR = 0.06). Test-retest reliability was found to be good (intraclass correlation coefficient ICC2,1 = 0.87, p &lt; 0.001, n = 118). The difference between participants with more than 9 years of clinical experience and those with less than 9 years of clinical experience (median split) was significant (t385 = 6.00, p &lt; 0.001), supporting known-groups validity. The results support construct validity and indicate good test-retest reliability of the DTI-G. The DTI-G can be used to measure and develop diagnostic ability of physiotherapists in clinical practice and education. Further research is necessary to validate the questionnaire for other health professions.

A Preclinical Course to Develop Clinical Reasoning Skills of First-year Medical Students

Background and Objectives: Clinical reasoning is developed sometime during medical school training. When and how this knowledge is attained is less clear. This study looks at clinical reasoning development after initiation of a rural experiential course for first-year medical students at the University of Minnesota Medical School, Duluth (regional) Campus.&#x0D; Methods: The Rural Medical Scholars Program course (RMSP) was developed to create a longitudinal rural family medicine experience for first and second-year students at the University of Minnesota Medical School Duluth. Sixty-three first year medical students participated in this required course and their clinical reasoning levels were measured using the Diagnostic Thinking Inventory (DTI). The DTI was given to the medical students after one year of participation in the RMSP course. A previous cohort before the RMSP course was developed was used as a control. A literature search was used for comparison to other schools that measured the DTI in their students.&#x0D; Results: Student diagnostic thinking performance as measured by the DTI after one year of the Rural Medical Scholars Program course significantly increased when compared to a previous cohort of first-year students who did not take the RMSP course. When compared to previously published DTI data, students after one year of RMSP had clinical reasoning levels of second through fourth-year students from other schools.&#x0D; Conclusions: The addition of a rural experiential course with family medicine preceptors significantly increased clinical reasoning levels of first-year medical students.&#x0D; &#x0D; Financial support: None&#x0D; Conflicts of Interests: No conflicts to report

(How) Can We Understand the Development of Clinical Reasoning?

Clinical reasoning is a topic that has received significant attention over the last decade, within both the academic and clinical communities. The numerous and varied publications in the Journal of Physical Therapy Education (JOPTE) reflect the profession's interest in studying clinical reasoning in physical therapy education and practice.In this issue, 4 papers address the topic of clinical reasoning. Drs Huhn and Parrott present a research report exploring the use of the Health Sciences Reasoning Test (HSRT) and academic measures (GPA and GRE scores) at the time of admission to predict physical therapist (PT) student success on the NPTE.1 This paper builds on Dr Huhn's prior work examining the utility of the HSRT in demonstrating development of critical thinking skills across PT education programs.2 Drs Venskus and Craig have developed and validated a tool to measure the degree of self-efficacy with respect to the development of clinical reasoning skills reported by PT students. This paper adds to the growing body of literature about the development of clinical reasoning, specifically addressing the student's capability to reason.3The other 2 papers in this issue are research reports that explore the development of clinical reasoning abilities. Dr. Gilliland has applied qualitative research methods to explore the development of diagnostic reasoning in PT students. She employed think aloud processes using a musculoskeletal paper case at 2 points in the students entry-level PT education to identify evolution of diagnostic reasoning.4 Drs Trommelen, Karpinski, and Chauvin studied the effectiveness of a novel instructional activity to promote reflection in a case-based delivery model for neuromuscular physical therapy.5 Like Drs Huhn and Parrott, these authors used standardized measures (the Diagnostic Thinking inventory and the Self-Assessment of Clinical Reasoning Tool) to demonstrate improvement in the student's clinical reasoning and reflective abilities. One of the challenges in conducting and applying this research is the varied methods and assessment tools that are used in studying clinical reasoning.Study of clinical reasoning in PT students has demonstrated that clinical reasoning abilities develop over time within PT curricula.6,7 Research on expertise has demonstrated the continued development of these clinical reasoning abilities beyond formal entry-level education. For example, a study of promising novices over a 2-year period as they entered practice indicated ongoing development and subsequent expansion and refinement of formal and informal learning, clinical skills, and collaboration.8 Findings such as these indicate the importance of creating opportunities to develop clinical reasoning skills as a student and novice practitioner.Another area of study in clinical reasoning has been the development of rubrics to assess clinical reasoning during practical assessment of student's clinical knowledge and skill performance. Two such assessment tools have been reported in JOPTE. The Think Aloud Standardized Patient Examination (TASPE)9 was developed to assess clinical reasoning competency in novice physical therapy students during standardized musculoskeletal patient encounters. Using the TASPE, students are assessed on their ability to synthesize data to inform think-aloud sessions across the hypothetico-deductive reasoning process: hypothesis generation, hypothesis evaluation, and intervention. A second tool, the Clinical Reasoning Grading Rubric, 10 has 2 intended purposes: (1) assess the clinical reasoning skills of PT students, and (2) evaluate readiness to progress to full-time clinical education. This tool incorporates assessment across cognitive, psychomotor, and affective domains with criteria from low to high performance of knowledge, skills, and attitudes.Another category of study is the development of skills that are components of clinical reasoning. Several studies exploring the development of critical thinking have been published in JOPTE over that past few years. …

Enhancing the Clinical Reasoning Skills of Postgraduate Students in Internal Medicine Through Medical Nonfiction and Nonmedical Fiction Extracurricular Books

ObjectiveTo improve the clinical reasoning skills of postgraduate students in internal medicine through 2 kinds of extracurricular books: medical nonfiction and nonmedical fiction. MethodsClinical reasoning is difficult to define, understand, observe, teach, and measure. This is an educational innovation under an experimental framework based on a cognitive intervention grounded in constructivist and cognitivist theories. This study was conducted from June 1, 2014, through May 31, 2015. It was a pre-post, randomized, controlled, prospective, mixed-methods, small-group study. The intervention was through medical nonfiction and nonmedical fiction books. The process was structured to ensure that the students would read the material in phases and reflect on them. Clinical reasoning (pretests and posttests) was quantitatively assessed using the Diagnostic Thinking Inventory (DTI) and clinical reasoning exercises (CREs) and their assessment using a rubric. A qualitative design was used, and face-to-face semistructured interviews were conducted. ResultsPosttest total scores (DTI=188.92; CREs=53.92) were higher for the study group after the intervention compared with its own pretest scores (DTI=165.25; CREs=41.17) and with the pretest (DTI=159.27; CRE=40.73) and posttest (DTI=166.91; CREs=41.18) scores of the control group. Interviews with the study group confirmed that the intervention was acceptable and useful in daily practice. ConclusionWe introduced, evaluated, and proved an approach to teaching-learning clinical reasoning based on the assumption that the clinical reasoning skills of postgraduate students in internal medicine can be enhanced through 2 kinds of extracurricular books and that fun as well as interest will enhance learning. This study is not only about teaching-learning clinical reasoning but also about the humanities in medical education.

Validation of the Quantitative Diagnostic Thinking Inventory for Athletic Training: A Pilot Study

Context: The cognitive process of making a clinical decision lies somewhere on a continuum between novices using hypothetico-deductive reasoning and experts relying more on case pattern recognition. Although several methods exist for measuring facets of clinical reasoning in specific situations, none have been experimentally applied, as of yet, to the profession of athletic training. The Diagnostic Thinking Inventory (DTI) has been used with medical doctors and medical students to determine their level of clinical reasoning as it applies to diagnosis making.Objective: To validate the DTI for Athletic Training (DTI-AT) and associated interview questions for use in the field of athletic training.Design: Mixed methodology.Setting: Online inventory and Skype-based interviews.Patients or Other Participants: Convenience sample of 25 senior-level athletic training students.Main Outcome Measure(s): Participants completed an online version of the DTI-AT which rated clinical reasoning tendencies on a 6-point Likert-type scale. Quantitative analysis consisted of determining means and ranges of scores along with reliability of total scores and subset scores. Randomly selected participants were interviewed online in order to provide validity of interview questions that were used to determine personal and professional activities that are either thought to enhance or hinder clinical reasoning. A secondary purpose was to solicit specific feedback that may enhance our understanding of the modified DTI.Results: A strong reliability was found for total DTI (r(41) = 0.846) and an acceptable reliability for flexibility in thinking (r(21) = 0.731) and structure of memory (r(20) = 0.771).Conclusions: The modifications of the DTI-AT demonstrated strong reliability and face validity. The DTI-AT may be an effective tool for determining clinical reasoning of athletic training students.

Functional neuroimaging correlates of thinking flexibility and knowledge structure in memory: Exploring the relationships between clinical reasoning and diagnostic thinking

Background: Diagnostic reasoning involves the thinking steps up to and including arrival at a diagnosis. Dual process theory posits that a physician’s thinking is based on both non-analytic or fast, subconscious thinking and analytic thinking that is slower, more conscious, effortful and characterized by comparing and contrasting alternatives. Expertise in clinical reasoning may relate to the two dimensions measured by the diagnostic thinking inventory (DTI): memory structure and flexibility in thinking.Aim: Explored the functional magnetic resonance imaging (fMRI) correlates of these two aspects of the DTI: memory structure and flexibility of thinking.Methods: Participants answered and reflected upon multiple-choice questions (MCQs) during fMRI. A DTI was completed shortly after the scan. The brain processes associated with the two dimensions of the DTI were correlated with fMRI phases – assessing flexibility in thinking during analytical clinical reasoning, memory structure during non-analytical clinical reasoning and the total DTI during both non-analytical and analytical reasoning in experienced physicians.Results: Each DTI component was associated with distinct functional neuroanatomic activation patterns, particularly in the prefrontal cortex.Conclusion: Our findings support diagnostic thinking conceptual models and indicate mechanisms through which cognitive demands may induce functional adaptation within the prefrontal cortex. This provides additional objective validity evidence for the use of the DTI in medical education and practice settings.