In Brief: Validity of Case Summaries in Written Examinations of Clinical Reasoning.
Construct: The purpose of this study was to provide initial evidence of the validity of written case summaries as assessments of clinical problem representation in a classroom setting.


BACKGROUND
To solve clinical problems, clinicians must gain a clear representation of the issues. In the clinical setting, oral case presentations-or summaries-are used to assess learners' ability to gather, synthesize, and "translate" pertinent case information. This ability can be assessed in Objective Structured Clinical Examination and Virtual Patient settings using oral or written case summaries. Evidence of their validity in these settings includes adequate interrater agreement and moderate correlation with other assessments of clinical reasoning. We examined the use of written case summaries in a classroom setting as part of an examination designed to assess clinical reasoning.


METHODS
We developed and implemented written examinations for 2 preclerkship general practice courses in Years 4 and 5 of a 7-year curriculum. Examinations included 8 case summary questions in Year 4 and 5 in Year 5. Seven hundred students participated. Cases were scored using 3 criteria: extraction of pertinent findings, semantic quality, and global ratings. We examined the item parameters (using classical test theory) and generalizability of case summary items. We computed correlations between case summary scores and scores on other questions within the examination.


RESULTS
Item parameters were acceptable (average item difficulty = 0.49-0.73 and 0.59-0.68 in Years 4 and 5; average point-biserials = 0.21-0.24 and 0.18-0.21). Scores were moderately generalizable (G coefficients = 0.40-0.50), with case-specificity a substantial source of measurement error (10.2%-19.5% of variance). Scoring and rater had small effects. Correlations with related constructs were low to moderate.


CONCLUSIONS
There is good evidence regarding the scoring and generalizability of written case summaries for assessment of clinical problem representation. Further evidence regarding the extrapolation and implications of these assessments is warranted.
a Department of Medicine and Centre for Medical Education, McGill University , Montreal , Quebec , Canada.|b Fonds de la Recherche Scientifique , Brussels , Belgium.|c Institut de Recherche Santé et Société, Université catholique de Louvain , Brussels , Belgium.
Valérie
V
Dory
d Centre of Pedagogy Applied to Health Sciences, Université de Montréal , Montreal , Quebec , Canada.
Robert
R
Gagnon
d Centre of Pedagogy Applied to Health Sciences, Université de Montréal , Montreal , Quebec , Canada.
Bernard
B
Charlin
c Institut de Recherche Santé et Société, Université catholique de Louvain , Brussels , Belgium.
Dominique
D
Vanpee
c Institut de Recherche Santé et Société, Université catholique de Louvain , Brussels , Belgium.
Sophie
S
Leconte
c Institut de Recherche Santé et Société, Université catholique de Louvain , Brussels , Belgium.
Corentin
C
Duyver
a Department of Medicine and Centre for Medical Education, McGill University , Montreal , Quebec , Canada.
Meredith
M
Young
e Département d'administration et fondements de l'éducation , Université de Montréal , Montreal , Quebec , Canada.
Nathalie
N
Loye
D002983:Clinical Competence; D004501:Education, Medical; D004521:Educational Measurement; D006801:Humans; D010808:Physical Examination; D015203:Reproducibility of Results
Assessment; clinical reasoning; generalizability study; problem solving; validity