Combination of different clinical reasoning tests in a national exam

Introduction: Clinical reasoning as a critical and high level of clinicalcompetency should be acquired during medical education, and medicaleducators should attempt to assess this ability in medical students. Nowadays,there are several ways to evaluate medical students’ clinical reasoningability in different countries worldwide. There are some well-known clinicalreasoning tests such as Key Feature (KF), Clinical Reasoning Problem(CRP), Script Concordance Test (SCT), and Comprehensive IntegrativePuzzle (CIP). Each of these tests has its advantages and disadvantages. In thisstudy, we evaluated the reliability of combination of clinical reasoning testsSCT, KF, CIP, and CRP in one national exam and the correlation between thesubtest scores of these tests together with the total score of the exam.Methods: A total of 339 high ranked medical students from 60 medicalschools in Iran participated in a national exam named “Medical Olympiad”.The ninth Medical Olympiad was held in Shahid Beheshti University ofMedical Sciences, Tehran, Iran, under the direct supervision of the Ministryof Health and Medical Education in summer 2017. The expert groupdesigned a combination of four types of clinical reasoning tests to assessboth analytical and non-analytical clinical reasoning. Mean scores of SCT,CRP, KF, and CIP were measured using descriptive statistics. Reliabilitywas calculated for each test and the combination of tests using Cronbach’salpha. Spearman’s correlation coefficient was used to evaluate the correlationbetween the score of each subtest and the total score. SPSS version 21 wasused for data analysis and the level of significance was considered <0.05.Results: The reliability of the combination of tests was 0.815. The reliability ofKF was 0.81 and 0.76, 0.80, and 0.92 for SCT, CRP, and CIP, respectively. Themean total score was 169.921±41.54 from 240. All correlations between eachclinical reasoning test and total score were significant (P<0.001). The highestcorrelation (0.887) was seen between CIP score and total score.Conclusion: The study showed that combining different clinical reasoningtests can be a reliable way of measuring this ability.