Clinical Reasoning Inventory: An Alternative Method to Measure Clinical Reasoning Skills

Background: The way medical knowledge is structured in the mind of students and clinicians is critical to the clinical reasoning. According to the illness scripts theory - in acquiring clinical reasoning - students progress through four transitory stages. The illness script theory has raised some practical questions such as, 'How can the progress of illness scripts development be evaluated?'

Aims: This study aims to develop a curriculum based instrument to assess the development of clinical reasoning skills based on stages indicated in illness script theory.

Instrument development and use: The method for instrument development suggested by Shea and Fortna was adopted in this study. Out of 1195 subjects involved in the validation process, the overall response rate was 80.75%. There was significance difference in the clinical reasoning inventory (CRI) score between the eight validation groups (p=0.000) with the more experienced groups scoring higher. The correlation between the CRI and the diagnostic thinking inventory scores was a significant low (r=0.233). The overall reliability was 0.8357. The discrimination indices for all 36 questions were above the standard.

Conclusion: There is positive evidence for the validity and reliability of the CRI; it can assess some form of specialised knowledge owned by experts; and in the context of Indonesian curriculum, it may be appropriate to formatively assess clinical students. The results may provide direct feedback to each individual student on their clinical reasoning skills, as well as areas for teaching learning improvement.