title: The assessment of student reasoning in the  context of a clinically oriented PBL program.
abstract: BACKGROUND
  Doctors' clinical reasoning ability significantly impacts upon their level of clinical competence. Throughout medical training students are given the opportunity to develop their reasoning ability in order to become appropriately clinically competent by graduation.
  
  
  OBJECTIVE
  To develop an instrument to assess students' reasoning ability on a written case-based question which was aligned to their learning in a PBL program.
  
  
  METHODS
  An instrument with 10 criteria centred upon hypothesis generation, learning issues and mechanistic explanations was developed. Experienced clinical and medical educators validated the instrument, prior to its use with 145 undergraduate first-year medical students.
  
  
  RESULTS
  The results enabled the establishment of the strengths and weaknesses in the reasoning performances of individuals, as well as the overall cohort. The instrument's Cronbach alpha coefficient was 0.94, and it had high inter-rater and intra-rater reliability. Further validation of the instrument's performance was established through qualitative evidence derived from student interviews and tutor reports for this cohort.
  
  
  CONCLUSIONS
  Aligning written assessment to the PBL process enables students and teachers to better understand how the reasoning process is developing for individuals and a cohort, and provides a basis for further investigation into the development of student clinical reasoning.
authors.affiliation: University of Adelaide, South Australia, Australia. kirsty.anderson@adelaide.edu.au
authors.forename: Kirsty
authors.initials: K
authors.lastname: Anderson
authors.forename: Ray
authors.initials: R
authors.lastname: Peterson
authors.forename: Anne
authors.initials: A
authors.lastname: Tonkin
authors.forename: Edward
authors.initials: E
authors.lastname: Cleary
mesh_terms: D000293:Adolescent; D004504:Education, Medical, Undergraduate; D004521:Educational Measurement / Q000379:methods*; D006801:Humans; D007407:Interviews as Topic; D018794:Problem-Based Learning; D013850:Thinking; D055815:Young Adult