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首页> 外文期刊>Military Medicine: Official Journal of AMSUS, The Society of the Federal Health Agencies >The Clinical Integrative Puzzle for Teaching and Assessing Clinical Reasoning: Preliminary Feasibility, Reliability, and Validity Evidence
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The Clinical Integrative Puzzle for Teaching and Assessing Clinical Reasoning: Preliminary Feasibility, Reliability, and Validity Evidence

机译：教学和评估临床推理的临床综合难题：初步可行性，可靠性和有效性证据

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Background: Expertise in clinical reasoning is essential for high-quality patient care. The Clinical Integrative Puzzle (CIP) is a novel assessment method for clinical reasoning. The purpose of our study was to further describe the CIP, providing feasibility, reliability, and validity evidence to support this tool for teaching and evaluating clinical reasoning. Methods: We conducted a prospective, randomized crossover trial assessing the CIP in second-year medical students from a single institution. Feasibility was estimated through the time taken to complete a CIP during a CIP session and through comments from faculty developers. Reliability was addressed through calculating odd-even item reliability (split-half procedure) for grid questions within each CIP. Evidence for content, concurrent, and predictive validity was also measured. Results: 36 students participated in the study. Data suggested successful randomization of participants and nonparticipants. The CIP was found to have high feasibility, acceptable reliability (0.43-0.73 with a mean of 0.60) with a short time for CIP completion. Spearman-Brown correction estimated a reliability of 0.75 with completing two grids (estimated time of 50 minutes) and 0.82 for three grids (estimated time of 75 minutes). Validity evidence was modest; the CIP is consistent with clinical reasoning literature and the CIP modestly correlated with small group performance (r = 0.3, p < 0.05). Conclusions: Assessing clinical reasoning in medical students is challenging. Our data provide good feasibility and reliability evidence for the use of CIPs; validity data was less robust.
机译：背景：临床推理方面的专业知识对于高质量的患者护理至关重要。临床整合难题（CIP）是一种用于临床推理的新颖评估方法。我们研究的目的是进一步描述CIP，提供可行性，可靠性和有效性证据，以支持该工具用于教学和评估临床推理。方法：我们进行了一项前瞻性，随机交叉试验，评估来自单个机构的二年级医学生的CIP。通过在CIP会话中完成CIP所花费的时间以及教师开发人员的评论来评估可行性。通过计算每个CIP中网格问题的奇偶项可靠性（平分程序）来解决可靠性问题。还测量了内容，并发和预测有效性的证据。结果：36名学生参加了研究。数据表明参与者和非参与者成功随机化。发现CIP具有很高的可行性，可接受的可靠性（0.43-0.73，平均值为0.60），并且完成CIP的时间很短。 Spearman-Brown校正估计完成两个网格（估计时间为50分钟）的可靠性为0.75，对于三个网格（估计时间为75分钟）的可靠性为0.82。有效性证据不充分; CIP与临床推理文献一致，而CIP与小组表现适度相关（r = 0.3，p <0.05）。结论：评估医学生的临床推理具有挑战性。我们的数据为使用CIP提供了良好的可行性和可靠性证据;有效性数据不那么可靠。

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