title: Variations in senior medical student diagnostic justification ability.
abstract: OBJECTIVE
  To determine the diagnostic justification proficiency of senior medical students across a broad spectrum of cases with common chief complaints and diagnoses.
  
  
  METHODS
  The authors gathered diagnostic justification exercise data from the Senior Clinical Comprehensive Examination taken by Southern Illinois University School of Medicine's students from the classes of 2011 (n = 67), 2012 (n = 66), and 2013 (n = 79). After interviewing and examining standardized patients, students listed their key findings and diagnostic possibilities considered, and provided a written explanation of how they used key findings to move from their initial differential diagnoses to their final diagnosis. Two physician judges blindly rated responses.
  
  
  RESULTS
  Student diagnostic justification performance was highly variable from case to case and often rated below expectations. Of the students in the classes of 2011, 2012, and 2013, 57% (38/67), 23% (15/66), and 33% (26/79) were judged borderline or poor on diagnostic justification performance for more than 50% of the cases on the examination.
  
  
  CONCLUSIONS
  Student diagnostic justification performance was inconsistent across the range of cases, common chief complaints, and underlying diagnoses used in this study. More than 20% of students exhibited borderline or poor diagnostic justification performance on more than 50% of the cases. If these results are confirmed in other medical schools, attention needs to be directed to investigating new curricular methods that ensure deliberate practice of these competencies across the spectrum of common chief complaints and diagnoses and do not depend on the available mix of patients.
authors.affiliation: Dr. Williams is adjunct professor, Department of Surgery, Indiana University School of Medicine, Indianapolis, Indiana. He is emeritus professor of medical education and J. Roland Folse Professor of Surgical Education Research and Development Emeritus, Southern Illinois University School of Medicine, Springfield, Illinois. Dr. Klamen is associate dean for education and curriculum and professor and chair, Department of Medical Education, Southern Illinois University School of Medicine, Springfield, Illinois. Mr. Markwell is director of statistics and research consulting, Department of Surgery, Southern Illinois University School of Medicine, Springfield, Illinois. Dr. Cianciolo is assistant professor of medical education, Southern Illinois University School of Medicine, Springfield, Illinois. Dr. Colliver is professor of medical education emeritus and past director of statistics and research consulting, Southern Illinois University School of Medicine, Springfield, Illinois. Dr. Verhulst is professor and director of statistics and research informatics, Center for Clinical Research, Southern Illinois University School of Medicine, Springfield, Illinois.
authors.forename: Reed G
authors.initials: RG
authors.lastname: Williams
authors.forename: Debra L
authors.initials: DL
authors.lastname: Klamen
authors.forename: Stephen J
authors.initials: SJ
authors.lastname: Markwell
authors.forename: Anna T
authors.initials: AT
authors.lastname: Cianciolo
authors.forename: Jerry A
authors.initials: JA
authors.lastname: Colliver
authors.forename: Steven J
authors.initials: SJ
authors.lastname: Verhulst
mesh_terms: D002982:Clinical Clerkship / Q000379:methods*; D002983:Clinical Competence; D003937:Diagnosis, Differential; D003951:Diagnostic Errors; D004504:Education, Medical, Undergraduate / Q000379:methods*; D004521:Educational Measurement; D005069:Evaluation Studies as Topic; D005260:Female; D006801:Humans; D007087:Illinois; D008297:Male; D008487:Medical History Taking; D010808:Physical Examination; D012577:Schools, Medical; D013337:Students, Medical / Q000706:statistics & numerical data; D055815:Young Adult