Evaluating the Clinical Reasoning of Student Health Professionals in Placement and Simulation Settings: A Systematic Review

(1) Background: Clinical reasoning is essential to the effective practice of autonomous health professionals and is, therefore, an essential capability to develop as students. This review aimed to systematically identify the tools available to health professional educators to evaluate students’ attainment of clinical reasoning capabilities in clinical placement and simulation settings. (2) Methods: A systemic review of seven databases was undertaken. Peer-reviewed, English-language publications reporting studies that developed or tested relevant tools were included. Searches included multiple terms related to clinical reasoning and health disciplines. Data regarding each tool’s conceptual basis and evaluated constructs were systematically extracted and analysed. (3) Results: Most of the 61 included papers evaluated students in medical and nursing disciplines, and over half reported on the Script Concordance Test or Lasater Clinical Judgement Rubric. A number of conceptual frameworks were referenced, though many papers did not reference any framework. (4) Conclusions: Overall, key outcomes highlighted an emphasis on diagnostic reasoning, as opposed to management reasoning. Tools were predominantly aligned with individual health disciplines and with limited cross-referencing within the field. Future research into clinical reasoning evaluation tools should build on and refer to existing approaches and consider contributions across professional disciplinary divides.

Creating Clinical Reasoning Assessment Tools in Different Languages: Adaptation of the Pediatric Emergency Medicine Script Concordance Test to Japanese

Introduction: Clinical reasoning is a crucial skill in the practice of pediatric emergency medicine and a vital element of the various competencies achieved during the clinical training of resident doctors. Pediatric emergency physicians are often required to stabilize patients and make correct diagnoses with limited clinical information, time and resources. The Pediatric Emergency Medicine Script Concordance Test (PEM-SCT) has been developed specifically for assessing physician's reasoning skills in the context of the uncertainties in pediatric emergency practice. In this study, we developed the Japanese version of the PEM-SCT (Jpem-SCT) and confirmed its validity by collecting relevant evidence.Methods: The Jpem-SCT was developed by translating the PEM-SCT into Japanese using the Translation, Review, Adjudication, Pretest, Documentation team translation model, which follows cross-cultural survey guidelines for proper translation and cross-cultural and linguistic equivalences between the English and Japanese version of the survey. First, 15 experienced pediatricians participated in the pre-test session, serving as a reference panel for modifying the test descriptions, incorporating Japanese context, and establishing the basis for the scoring process. Then, a 1-h test containing 60 questions was administered to 75 trainees from three academic institutions. Following data collection, we calculated the item-total correlations of the scores to optimize selection of the best items in the final version of the Jpem-SCT. The reliability of the finalized Jpem-SCT was calculated using Cronbach's α coefficient for ensuring generalizability of the evidence. We also conducted multiple regression analysis of the test score to collect evidence on validity of the extrapolation.Results: The final version of the test, based on item-total correlation data analysis, contained 45 questions. The participant's specialties were as follows: Transitional interns 12.0%, pediatric residents 56.0%, emergency medicine residents 25.3%, and PEM fellows 6.7%. The mean score of the final version of the Jpem-SCT was 68.6 (SD 9.8). The reliability of the optimized test (Cronbach's α) was 0.70. Multiple regression analysis showed that being a transitional intern was a negative predictor of test scores, indicating that clinical experience relates to performance on the Jpem-SCT.Conclusion: This pediatric emergency medicine Script Concordance Test was reliable and valid for assessing the development of clinical reasoning by trainee doctors during residency training.

The Use of a Modified Script Concordance Test in Clinical Rounds to Foster and Assess Clinical Reasoning Skills

The development of clinical reasoning skills is a high priority during clinical service, but an unpredictable case load and limited time for formal instruction makes it challenging for faculty to foster and assess students’ individual clinical reasoning skills. We developed an assessment for learning activity that helps students build their clinical reasoning skills based on a modified version of the script concordance test (SCT). To modify the standard SCT, we simplified it by limiting students to a 3-point Likert scale instead of a 5-point scale and added a free-text box for students to provide justification for their answer. Students completed the modified SCT during clinical rounds to prompt a group discussion with the instructor. Student feedback was positive, and the instructor gained valuable insight into the students’ thought process. A modified SCT can be adopted as part of a multimodal approach to teaching on the clinic floor. The purpose of this article is to describe our modifications to the standard SCT and findings from implementation in a clinical rounds setting as a method of formative assessment for learning and developing clinical reasoning skills.

Porcine Reproductive and Respiratory Syndrome Surveillance in breeding Herds and Nurseries Using Tongue Tips from Dead Animals

The detection capacity of Porcine Reproductive and Respiratory Syndrome virus (PRRSV) in tongues from dead animals in breeding herds (stillborns and piglets dying during the lactating period) and nursery farms (naturally dead animals) for PRRSV surveillance was evaluated. The samples were selected if pairs of serum and tongues were available from 2018 to 2020. Serum (pools of five) and exudate from tongues (one bag) were analyzed by PRRSV RT-PCR. The agreement between the serum sample procedure versus tongues exudate was assessed using a concordance test (Kappa statistic) at batch level. A total of 32 submissions, corresponding to 14 farms, had PRRSV diagnostic information for serum and tongues exudate. The overall agreement of batch classification as positive or negative, based on RT-PCR PRRSV results, between serum and tongue exudate of the 32 pairs was 76.9%. Cohen’s Kappa was 0.55. The main discrepancy came from the presence of positive samples in tongues exudate and not in serum, suggesting that tongue exudate to monitor PRRSV seems to be more sensitive than serum. These results suggest that this sample procedure could be also used for PRRSV surveillance and monitoring.

Insights for medical education: via a mathematical modelling of gamification

Introduction: Gamification has been shown to improve academic gains, but the mechanism remains elusive. We aim to understand how psychological constructs interact, and influence medical education using mathematical modelling. Methods: Studying a group of medical students (n=100; average age: 20) over a period of 4 years with the Personal Responsibility Orientation to Self-Direction in Learning Scale (PRO-SDLS) survey. Statistical tests (Paired t-test) and models (logistic regression) were used to decipher the changes within these psychometric constructs (Motivation, Control, Self-efficacy & Initiative), with gamification as a tool. Students were encouraged to partake in a maze (10 stations) that challenged them to answer anatomical questions using potted human specimens. Results: We found that the combinatorial effects of the maze and Script Concordance Test (SCT) resulted in a significant improvement for “Self-Efficacy” and “Initiative” (p<0.05). However, the “Motivation” construct was not improved significantly with the maze alone (p<0.05). Interestingly, the “Control” construct was eroded in students not exposed to gamification (p<0.05). All these findings were supported by key qualitative comments such as “helpful”, “fun” and “knowledge gap” by the participants (self-awareness of their thought processes). Students found gamification reinvigorating and useful in their learning of clinical anatomy. Conclusion: Gamification could influence some psychometric constructs for medical education, and by extension, the metacognition of the students. This was supported by the improvements shown in the SCT results. It is therefore proposed that gamification be further promoted in medical education. In fact, its usage should be more universal in education.

Individual versus Team-Based responses to Script Concordance Test in Teaching Clinical Reasoning

Introduction: Although clinical competence is multi-dimensional and should be acquired by each medical student, but most students learn clinical reasoning skills informally in clinical rotations. Accordingly, A prospective quasi-experimental study was conducted aiming to evaluate the merging of Script Concordance Test (SCT) and Team Based Learning (TBL) as a teaching/learning approach in clinical setting for medical students. Methodology: The study ran in three phases. Phase 1 (preparatory phase) involved students’ preparation and preparation of SCT. Phase 2 (implementation phase) included application of individual and team SCT (iSCT and tSCT respectively). Phase 3 (evaluation phase) compared score results and obtained students’ feedback.Results: Significant differences existed when comparing individual students’ response or students’ teams’ responses with experts scores. However, the use of the SCT/TBL approach had improved the clinical reasoning skills of the students in some vignettes and helped the lower achievers through the tSCT. The students found the approach appropriate for teaching or formatively assessing clinical reasoning. It helped them to discuss, correct their mistakes and improve their problem solving and reasoning skills. Conclusion: team-based learning improved students’ responses, especially the lower achievers, to script concordance test. SCT/TBL approach can be used to teach clinical reasoning for undergraduate students.

Traditional Sporting Games as Emotional Communities: The Case of Alcover and Moll’s Catalan–Valencian–Balearic Dictionary

Learning to live together is the central concern of education everywhere in the world (UNESCO). Traditional sporting games (TSGs) provide interpersonal experiences that shape miniature communities charged with emotional meanings. The objective of this study was to analyze the ethnomotor features of TSG (relationship between the internal characteristics of the TSG and sociocultural variables) in three Catalan-speaking Autonomous Communities and to interpret them for constructing emotional communities. The study followed a phenomenological-interpretative paradigm. The identification of TSG was done by a hermeneutic methodological approach by using an exhaustive exploratory documentary research. We studied 503 games collected in the Dictionary Català-Valencià-Balear de Alcover and Moll (1926–1963). Instruments and procedure: A database was built up with information about the internal and external logic of the games. The validity of the information was confirmed by means of a concordance test between the researchers. Data processing was carried out by means of classification trees (inferential level), identifying the predictive variables of the types of TSG. Most of the TSGs were sociomotor games (n = 405/503; 80.5%). The classification tree identified four explanatory variables. Three variables were internal traits (body contact, material, and score), and one variable corresponded to external logic (age). Features of the TSG of the Catalan-speaking Autonomous Communities build original emotional communities. The ethnomotor regularities triggered emotional experiences associated with pleasure for (a) living together (predominance of sociomotor games); (b) domesticating of aggressiveness over opponents (different motor licit aggressiveness); (c) developing sustainability (presence and absence of objects from the surrounding environment); (d) educating the competition (games with and without final score); and (e) interpersonal well-being based on the community (transmission of ludic culture from children to young TSG).