Optimizing OSCE for clinical reasoning assessment: correlation of Clinical Reasoning Indicators-History Taking Scale with traditional checklist

Abstract

Background: Clinical reasoning is defined as amultidimensional construct which has multiple assessment methods available to measure it. The Clinical Reasoning Indicators—History Taking—Scale (CRI-HT-S) is a novel tool that assesses clinical reasoning during history taking on a 5-point Likert scale. This study aimed to measure clinical reasoning of undergraduate medical students using this novel tool and correlate its score with traditional checklist-based Objective Structured Clinical Examination (OSCE) scores. Methods: This study employed correlational design. A nonprobability sample of 115 female undergraduate medical students in the final year of the integrated medical program for the bachelor’s degree provided by the faculty of medicine for girls, Al-Azhar University, Cairo, participated in the study. After training the assessors, the study incorporated the Clinical Reasoning Indicators—History Taking—Scale (CRI-HT-S) into the abdominal pain history- taking OSCE station as an additional assessment tool. Descriptive statistics were used for quantitative data. The Pearson correlation test assessed the association between history-taking checklist scores and CRI-HT-S scores, with a significance level set at p < 0.05. Results: The clinical reasoning skills scores were variable. The highest scores belonged to “taking the lead” skill, and the lowest were checking with patients, collecting data and effectiveness of the conversation skills. There was a statistically significant weak positive correlation between history-taking checklist scores and the total CRI-HT-S score among undergraduate medical students, and results also exhibited weak positive correlations with four of the individual clinical reasoning indicators’ scores. Conclusions: Study participants are relatively skillful during history-taking at taking the lead with the patient and recognizing and responding to relevant information. Incorporating the CRI-HT-S into OSCE provided a structured approach to measuring clinical reasoning in history-taking stations.