title: Assessing clinical reasoning abilities of medical students using clinical performance examination.
abstract: OBJECTIVE
  The purpose of this study is to investigate the reliability and validity of new clinical performance examination (CPX) for assessing clinical reasoning skills and evaluating clinical reasoning ability of the students.
  
  
  METHODS
  Third-year medical school students (n=313) in Busan-Gyeongnam consortium in 2014 were included in the study. One of 12 stations was developed to assess clinical reasoning abilities. The scenario and checklists of the station were revised by six experts. Chief complaint of the case was rhinorrhea, accompanied by fever, headache, and vomiting. Checklists focused on identifying of the main problem and systematic approach to the problem. Students interviewed the patient and recorded subjective and objective findings, assessments, plans (SOAP) note for 15 minutes. Two professors assessed students simultaneously. We performed statistical analysis on their scores and survey.
  
  
  RESULTS
  The Cronbach α of subject station was 0.878 and Cohen κ coefficient between graders was 0.785. Students agreed on CPX as an adequate tool to evaluate students' performance, but some graders argued that the CPX failed to secure its validity due to their lack of understanding the case. One hundred eight students (34.5%) identified essential problem early and only 58 (18.5%) performed systematic history taking and physical examination. One hundred seventy-three of them (55.3%) communicated correct diagnosis with the patient. Most of them had trouble in writing SOAP notes.
  
  
  CONCLUSIONS
  To gain reliability and validity, interrater agreement should be secured. Students' clinical reasoning skills were not enough. Students need to be trained on problem identification, reasoning skills and accurate record-keeping.
authors.affiliation: Medical Education Unit, Pusan National University School of Medicine, Busan, Korea.
authors.forename: Sunju
authors.initials: S
authors.lastname: Im
authors.affiliation: Department of Medical Humanities, Dong-A University College of Medicine, Busan, Korea.
authors.forename: Do-Kyong
authors.initials: DK
authors.lastname: Kim
authors.affiliation: Department of Parasitology, Dong-A University College of Medicine, Busan, Korea.
authors.forename: Hyun-Hee
authors.initials: HH
authors.lastname: Kong
authors.affiliation: Department of Medical Education, Inje University College of Medicine, Busan, Korea.
authors.forename: Hye-Rin
authors.initials: HR
authors.lastname: Roh
authors.affiliation: Department of Obstetrics & Gynecology, Kosin University College of Medicine, Busan, Korea.
authors.forename: Young-Rim
authors.initials: YR
authors.lastname: Oh
authors.affiliation: Department of Pediatrics, Gyeongsang National University School of Medicine, Jinju, Korea.
authors.forename: Ji-Hyun
authors.initials: JH
authors.lastname: Seo
mesh_terms: D057189:Checklist; D002983:Clinical Competence; D003142:Communication; D032882:Comprehension; D004504:Education, Medical, Undergraduate; D004521:Educational Measurement / Q000592:standards*; D006801:Humans; D008487:Medical History Taking; D008499:Medical Records; D015588:Observer Variation; D010808:Physical Examination; D010817:Physician-Patient Relations; D018794:Problem-Based Learning; D015203:Reproducibility of Results; D056910:Republic of Korea; D012577:Schools, Medical; D013337:Students, Medical; D011795:Surveys and Questionnaires; D013850:Thinking; D014495:Universities
keywords: Clinical competence; Educational measurement; Reproducibility of results
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