title: Tracking development of clinical reasoning ability across five medical schools using a progress test.
abstract: OBJECTIVE
  Little is known about the acquisition of clinical reasoning skills in medical school, the development of clinical reasoning over the medical curriculum as a whole, and the impact of various curricular methodologies on these skills. This study investigated (1) whether there are differences in clinical reasoning skills between learners at different years of medical school, and (2) whether there are differences in performance between students at schools with various curricular methodologies.
  
  
  METHODS
  Students (n = 2,394) who had completed zero to three years of medical school at five U.S. medical schools participated in a cross-sectional study in 2008. Students took the same diagnostic pattern recognition (DPR) and clinical data interpretation (CDI) tests. Percent correct scores were used to determine performance differences. Data from all schools and students at all levels were aggregated for further analysis.
  
  
  RESULTS
  Student performance increased substantially as a result of each year of training. Gains in DPR and CDI performance during the third year of medical school were not as great as in previous years across the five schools. CDI performance and performance gains were lower than DPR performance and gains. Performance gains attributable to training at each of the participating medical schools were more similar than different.
  
  
  CONCLUSIONS
  Years of training accounted for most of the variation in DPR and CDI performance. As a rule, students at higher training levels performed better on both tests, though the expected larger gains during the third year of medical school did not materialize.
authors.affiliation: Department of Surgery, Southern Illinois University School of Medicine, Springfield, 62794-9622, USA.
authors.forename: Reed G
authors.initials: RG
authors.lastname: Williams
authors.forename: Debra L
authors.initials: DL
authors.lastname: Klamen
authors.forename: Christopher B
authors.initials: CB
authors.lastname: White
authors.forename: Emil
authors.initials: E
authors.lastname: Petrusa
authors.forename: Ruth-Marie E
authors.initials: RM
authors.lastname: Fincher
authors.forename: Carol F
authors.initials: CF
authors.lastname: Whitfield
authors.forename: John H
authors.initials: JH
authors.lastname: Shatzer
authors.forename: Teresita
authors.initials: T
authors.lastname: McCarty
authors.forename: Bonnie M
authors.initials: BM
authors.lastname: Miller
mesh_terms: D002983:Clinical Competence; D003430:Cross-Sectional Studies; D019937:Diagnostic Techniques and Procedures; D004504:Education, Medical, Undergraduate; D004521:Educational Measurement; D006801:Humans; D018794:Problem-Based Learning; D012577:Schools, Medical; D013337:Students, Medical; D014481:United States