ContExtended Questions (CEQ) to Teach and Assess Clinical Reasoning: A New Variant of F-Type Testlets
Abstract
This study introduces ContExtended Questions (CEQ), which is a tool both to teach and assess clinical reasoning particularly in the preclinical years, and the web-based program to implement. CEQ consists of text-based case-based multiple-choice questions that provide patient data in a fixed and predetermined sequence. It enables the examinees to develop and reshape their illness scripts by using feedback after every question. Feedback operates to transform the examinee’s failure into a “productive failure”. The preliminary results of the randomized controlled experiment of teaching clinical reasoning to preclinical students through CEQ is quite satisfactory. In the medical education literature, this would be the first time that students, who have no or very limited clinical experience, developed their illness scripts just by taking formative multiple-choice tests. The approach would be named “test-only learning”. The complete results of the experiment and then more experiments in other contexts and domains are necessary to establish a more powerful assessment tool and software. Furthermore, by changing the content of the questions, it is possible to use CEQ in every period of medical education and health professions education.
Downloads
Metrics
References
Norman G. Research in clinical reasoning: past history and current trends. Med Educ, 2005, 39(4), 418-427. DOI: 10.1111/j.1365-2929.2005.02127.x https://onlinelibrary.wiley.com/doi/full/10.1111/j.1365-2929.2005.02127.x
Custers EJ. Thirty years of illness scripts: Theoretical origins and practical applications. Med Teach, 2015, 37(5), 457-462. DOI: 10.3109/0142159X.2014.956052 https://www.tandfonline.com/doi/full/10.3109/0142159X.2014.956052
Cooper N, Da Silva AL, Powell S. Teaching clinical reasoning. En ABC of Clinical Reasoning; 1. ed.; Cooper N, Frain J, Eds.; Editorial: Chichester, UK, 2016, 44-50.
Kassirer JP. Teaching clinical reasoning: case-based and coached. Acad Med 2010, 85(7), 1118-1124. DOI: 10.1097/ACM.0b013e3181d5dd0d https://journals.lww.com/academicmedicine/Fulltext/2010/07000/Teaching_Clinical_Reasoning__Case_Based_and.11.aspx
Ten Cate O, Custers EJ, Durning SJ, Eds. Principles and Practice of Case-based Clinical Reasoning Education: A Method for Preclinical Students. Springer, 2018. https://www.springer.com/gp/book/9783319648279
Schank RC, Abelson RP. Scripts, plans, and knowledge. IJCAI 1975, 75, 151-157. https://home.mis.u-picardie.fr/~furst/docs/Schank_Abelson_Scripts_1975.pdf
Wainer H, Bradlow ET, Wang X. Testlet response theory and its applications. Cambridge, UK, 2007.
Jolly B, Dalton MJ. Written Assessment. En Understanding medical education: evidence, theory and practice; Swanwick T, Forrest K, O’Brien BC, Eds.; New Jersey, USA, 2019, 291-317.
Durak HI, Caliskan SA, Bor S, Van Der Vleuten C. Use of case-based exams as an instructional teaching tool to teach clinical reasoning. Med Teach, 2007, 29(6), e170-e174. DOI: 10.1080/01421590701506866 https://www.tandfonline.com/doi/full/10.1080/01421590701506866
Lubarsky S, Dory V, Audétat MC, Custers E, Charlin B. Using script theory to cultivate illness script formation and clinical reasoning in health professions education. Can Med Educ J, 2015, 6(2), e61. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4795084/
Cooper N, Bartlett M, Gay S, Hammond A, Lillicrap M, Matthan J, Singh M. UK Clinical Reasoning in Medical Education (CReME) consensus statement group. Consensus statement on the content of clinical reasoning curricula in undergraduate medical education. Med Teach, 2020, 1-8. DOI: 10.1080/0142159X.2020.1842343 https://www.tandfonline.com/doi/full/10.1080/0142159X.2020.1842343
Haladayna TM, Downing SM, Rodriguez MC. A review of multiple-choice item-writing guidelines for classroom assessment. Appl Meas Educ, 2002, 15(3), 309-333. DOI: 10.1207/S15324818AME1503_5 https://www.tandfonline.com/doi/abs/10.1207/S15324818AME1503_5
Pugh D, De Champlain A, Touchie C. Plus ça change, plus c’est pareil: making a continued case for the use of MCQs in medical education. Med Teach, 2019, 41(5), 569-577. DOI: 10.1080/0142159X.2018.1505035 https://www.tandfonline.com/doi/full/10.1080/0142159X.2018.1505035
Shumway JM, Harden RM. AMEE Guide No. 25: The assessment of learning outcomes for the competent and reflective physician. Med Teach, 2003, 25(6), 569-584. DOI: 10.1080/0142159032000151907 https://www.tandfonline.com/doi/abs/10.1080/0142159032000151907
Kapur M. Productive failure. Cogn Instr, 2008, 26(3), 379-424. DOI: 10.1080/07370000802212669 https://www.tandfonline.com/doi/full/10.1080/07370000802212669
Steenhof N, Woods NN, Van Gerven PW, Mylopoulos M. Productive failure as an instructional approach to promote future learning. Adv Health Sci Educ, 2019, 24(4), 739-749. DOI: 10.1007/s10459-019-09895-4 https://link.springer.com/article/10.1007/s10459-019-09895-4
Ramani S, Krackov SK. Twelve tips for giving feedback effectively in the clinical environment. Med Teach, 2012, 34(10), 787-791. DOI: 10.3109/0142159X.2012.684916 https://www.tandfonline.com/doi/full/10.3109/0142159X.2012.684916
Butler AC, Roediger HL. Feedback enhances the positive effects and reduces the negative effects of multiple-choice testing. Mem Cognit, 2008, 36(3), 604-616. DOI: 10.3758/MC.36.3.604 https://link.springer.com/article/10.3758/MC.36.3.604
Black P, Wiliam D. Assessment and classroom learning. Assessment in education: principles. Policy Pract, 2006, 5(1), 7–74. DOI: 10.1080/0969595980050102 https://www.tandfonline.com/doi/abs/10.1080/0969595980050102
Sandars J. The use of reflection in medical education: AMEE Guide No. 44. Med Teach, 2009, 31(8), 685-695. DOI: 10.1080/01421590903050374 https://www.tandfonline.com/doi/full/10.1080/01421590903050374
Nendaz MR, Raetzo MA, Junod AF, Vu NV. Teaching diagnostic skills: clinical vignettes or chief complaints?. Adv Health Sci Educ, 2000, 5(1), 3-10. DOI: 10.1023/A:1009887330078 https://link.springer.com/article/10.1023/A:1009887330078
Pinnock R, Anakin M, Lawrence J, Chignell H, Wilkinson T. Identifying developmental features in students’ clinical reasoning to inform teaching. Med Teach, 2019, 41(3), 297-302. DOI: 10.1080/0142159X.2018.1463433 https://www.tandfonline.com/doi/full/10.1080/0142159X.2018.1463433
Schmidt HG, Mamede S. How to improve the teaching of clinical reasoning: a narrative review and a proposal. Med Educ, 2015, 49(10), 961-973. DOI: 10.1111/medu.12775 https://onlinelibrary.wiley.com/doi/full/10.1111/medu.12775
Durning SJ, Artino AR. Situativity theory: a perspective on how participants and the environment can interact: AMEE Guide no. 52. Med Teach, 2011, 33(3), 188-199. DOI: 10.3109/0142159X.2011.550965 https://www.tandfonline.com/doi/full/10.3109/0142159X.2011.550965
Copyright (c) 2021 Servicio de Publicaciones de la Universidad de Murcia
This work is licensed under a Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License.
The works published in this magazine are subject to the following terms:
1. The Publications Service of the University of Murcia (the publisher) preserves the economic rights (copyright) of the published works and favors and allows them to be reused under the use license indicated in point 2.
2. The works are published under a Creative Commons Attribution-NonCommercial-NoDerivative 4.0 license.
3. Self-archiving conditions. Authors are allowed and encouraged to disseminate electronically the pre-print versions (version before being evaluated and sent to the journal) and / or post-print (version evaluated and accepted for publication) of their works before publication , since it favors its circulation and earlier diffusion and with it a possible increase in its citation and reach among the academic community.
