title: Electronic assessment of clinical reasoning in clerkships: A mixed-methods comparison of long-menu key-feature problems with context-rich single best answer questions.
abstract: BACKGROUND
  It remains unclear which item format would best suit the assessment of clinical reasoning: context-rich single best answer questions (crSBAs) or key-feature problems (KFPs). This study compared KFPs and crSBAs with respect to students' acceptance, their educational impact, and psychometric characteristics when used in a summative end-of-clinical-clerkship pediatric exam.
  
  
  METHODS
  Fifth-year medical students (n = 377) took a computer-based exam that included 6-9 KFPs and 9-20 crSBAs which assessed their clinical reasoning skills, in addition to an objective structured clinical exam (OSCE) that assessed their clinical skills. Each KFP consisted of a case vignette and three key features using a "long-menu" question format. We explored students' perceptions of the KFPs and crSBAs in eight focus groups and analyzed statistical data of 11 exams.
  
  
  RESULTS
  Compared to crSBAs, KFPs were perceived as more realistic and difficult, providing a greater stimulus for the intense study of clinical reasoning, and were generally well accepted. The statistical analysis revealed no difference in difficulty, but KFPs resulted more reliable and efficient than crSBAs. The correlation between the two formats was high, while KFPs correlated more closely with the OSCE score.
  
  
  CONCLUSIONS
  KFPs with long-menu exams seem to bring about a positive educational effect without psychometric drawbacks.
authors.affiliation: a Department of Assessment and Evaluation, Institute of Medical Education Bern , University of Bern , Bern, Switzerland.
authors.forename: Sören
authors.initials: S
authors.lastname: Huwendiek
authors.affiliation: b Department of Pediatric Cardiology and Intensive Care Medicine , Klinikum Stuttgart, Stuttgart , Germany.
authors.forename: Friedrich
authors.initials: F
authors.lastname: Reichert
authors.affiliation: c Clinic for Child and Adolescent Psychiatry, University Hospital Kiel , Germany.
authors.forename: Cecilia
authors.initials: C
authors.lastname: Duncker
authors.affiliation: d Institute of Medical Education (IfAS), Faculty of Medicine, University of Muenster, Münster , Germany.
authors.forename: Bas A
authors.initials: BA
authors.lastname: de Leng
authors.affiliation: e Department of Educational Development and Research , Maastricht University, Maastricht , the Netherlands.
authors.forename: Cees P M
authors.initials: CPM
authors.lastname: van der Vleuten
authors.affiliation: e Department of Educational Development and Research , Maastricht University, Maastricht , the Netherlands.
authors.forename: Arno M M
authors.initials: AMM
authors.lastname: Muijtjens
authors.affiliation: f Clinic for General Paediatrics, Neonatology and Paediatric Cardiology, University Children's Hospital Düsseldorf, Düsseldorf , Germany.
authors.forename: Hans-Martin
authors.initials: HM
authors.lastname: Bosse
authors.affiliation: g GECKO Institute of Medicine, Informatics & Economics, Heilbronn University, Heilbronn , Germany.
authors.forename: Martin
authors.initials: M
authors.lastname: Haag
authors.affiliation: h Clinic I, University Children's Hospital Heidelberg, Heidelberg , Germany.
authors.forename: Georg F
authors.initials: GF
authors.lastname: Hoffmann
authors.affiliation: h Clinic I, University Children's Hospital Heidelberg, Heidelberg , Germany.
authors.forename: Burkhard
authors.initials: B
authors.lastname: Tönshoff
authors.affiliation: e Department of Educational Development and Research , Maastricht University, Maastricht , the Netherlands.
authors.forename: Diana
authors.initials: D
authors.lastname: Dolmans
mesh_terms: D002982:Clinical Clerkship; D002983:Clinical Competence; D004521:Educational Measurement / Q000379:methods*; D006801:Humans; D011340:Problem Solving; D013337:Students, Medical