Exploring how students think: a new method combining think-aloud and concept mapping protocols.
OBJECTIVE
A key element of medical competence is problem solving. Previous work has shown that doctors use inductive reasoning to progress from facts to hypotheses and deductive reasoning to move from hypotheses to the gathering of confirmatory information. No individual assessment method has been designed to quantify the use of inductive and deductive procedures within clinical reasoning. The aim of this study was to explore the feasibility and reliability of a new method which allows for the rapid identification of the style (inductive or deductive) of clinical reasoning in medical students and experts.


METHODS
The study included four groups of four participants. These comprised groups of medical students in Years 3, 4 and 5 and a group of specialists in internal medicine, all at a medical school with a 6-year curriculum in France. Participants were asked to solve four clinical problems by thinking aloud. The thinking expressed aloud was immediately transcribed into concept maps by one or two 'writers' trained to distinguish inductive and deductive links. Reliability was assessed by estimating the inter-writer correlation. The calculated rate of inductive reasoning, the richness score and the rate of exhaustiveness of reasoning were compared according to the level of expertise of the individual and the type of clinical problem.


RESULTS
The total number of maps drawn amounted to 32 for students in Year 4, 32 for students in Year 5, 16 for students in Year 3 and 16 for experts. A positive correlation was found between writers (R = 0.66-0.93). Richness scores and rates of exhaustiveness of reasoning did not differ according to expertise level. The rate of inductive reasoning varied as expected according to the nature of the clinical problem and was lower in experts (41% versus 67%).


CONCLUSIONS
This new method showed good reliability and may be a promising tool for the assessment of medical problem-solving skills, giving teachers a means of diagnosing how their students think when they are confronted with clinical problems.
Pottier
Pierre
P
Department of Internal Medicine, Nantes University Hospital Centre, Nantes, FranceTeam for Biostatistics (EA 4572), Department of Clinical Research and Subjective Measures in Health Science, University of Nantes, Nantes, FranceWilson Centre for Research in Education, University of Toronto, Toronto, Ontario, CanadaDepartment of Psychiatry, University of Toronto, Toronto, Ontario, Canada.
Hardouin
Jean-Benoit
JB
Department of Internal Medicine, Nantes University Hospital Centre, Nantes, FranceTeam for Biostatistics (EA 4572), Department of Clinical Research and Subjective Measures in Health Science, University of Nantes, Nantes, FranceWilson Centre for Research in Education, University of Toronto, Toronto, Ontario, CanadaDepartment of Psychiatry, University of Toronto, Toronto, Ontario, Canada.
Hodges
Brian D
BD
Department of Internal Medicine, Nantes University Hospital Centre, Nantes, FranceTeam for Biostatistics (EA 4572), Department of Clinical Research and Subjective Measures in Health Science, University of Nantes, Nantes, FranceWilson Centre for Research in Education, University of Toronto, Toronto, Ontario, CanadaDepartment of Psychiatry, University of Toronto, Toronto, Ontario, Canada.
Pistorius
Marc-Antoine
MA
Department of Internal Medicine, Nantes University Hospital Centre, Nantes, FranceTeam for Biostatistics (EA 4572), Department of Clinical Research and Subjective Measures in Health Science, University of Nantes, Nantes, FranceWilson Centre for Research in Education, University of Toronto, Toronto, Ontario, CanadaDepartment of Psychiatry, University of Toronto, Toronto, Ontario, Canada.
Connault
Jérome
J
Department of Internal Medicine, Nantes University Hospital Centre, Nantes, FranceTeam for Biostatistics (EA 4572), Department of Clinical Research and Subjective Measures in Health Science, University of Nantes, Nantes, FranceWilson Centre for Research in Education, University of Toronto, Toronto, Ontario, CanadaDepartment of Psychiatry, University of Toronto, Toronto, Ontario, Canada.
Durant
Cécile
C
Department of Internal Medicine, Nantes University Hospital Centre, Nantes, FranceTeam for Biostatistics (EA 4572), Department of Clinical Research and Subjective Measures in Health Science, University of Nantes, Nantes, FranceWilson Centre for Research in Education, University of Toronto, Toronto, Ontario, CanadaDepartment of Psychiatry, University of Toronto, Toronto, Ontario, Canada.
Clairand
Renaud
R
Department of Internal Medicine, Nantes University Hospital Centre, Nantes, FranceTeam for Biostatistics (EA 4572), Department of Clinical Research and Subjective Measures in Health Science, University of Nantes, Nantes, FranceWilson Centre for Research in Education, University of Toronto, Toronto, Ontario, CanadaDepartment of Psychiatry, University of Toronto, Toronto, Ontario, Canada.
Sebille
Véronique
V
Department of Internal Medicine, Nantes University Hospital Centre, Nantes, FranceTeam for Biostatistics (EA 4572), Department of Clinical Research and Subjective Measures in Health Science, University of Nantes, Nantes, FranceWilson Centre for Research in Education, University of Toronto, Toronto, Ontario, CanadaDepartment of Psychiatry, University of Toronto, Toronto, Ontario, Canada.
Barrier
Jacques-Henri
JH
Department of Internal Medicine, Nantes University Hospital Centre, Nantes, FranceTeam for Biostatistics (EA 4572), Department of Clinical Research and Subjective Measures in Health Science, University of Nantes, Nantes, FranceWilson Centre for Research in Education, University of Toronto, Toronto, Ontario, CanadaDepartment of Psychiatry, University of Toronto, Toronto, Ontario, Canada.
Planchon
Bernard
B
Department of Internal Medicine, Nantes University Hospital Centre, Nantes, FranceTeam for Biostatistics (EA 4572), Department of Clinical Research and Subjective Measures in Health Science, University of Nantes, Nantes, FranceWilson Centre for Research in Education, University of Toronto, Toronto, Ontario, CanadaDepartment of Psychiatry, University of Toronto, Toronto, Ontario, Canada.
D003071:Cognition / Q000502:physiology*; D003479:Curriculum; D003657:Decision Making / Q000502:physiology*; D004504:Education, Medical, Undergraduate / Q000379:methods*; D006801:Humans; D011340:Problem Solving / Q000502:physiology*; D013337:Students, Medical / Q000523:psychology*; D013850:Thinking