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Facets of reasoning competence influenced by an explicit insight into cognitive psychology features during clinical reasoning seminars have not been specifically explored.This prospective, controlled study, conducted at the University of Geneva Faculty of Medicine, Switzerland, assessed the impact on sixth-year medical students' patient work-up of case-based reasoning seminars, bringing them explicit insight into cognitive aspects of their reasoning.Volunteer students registered for our three-month Internal Medicine elective were assigned to one of two training conditions: standard (control) or modified (intervention) case-based reasoning seminars. These seminars start with the patient's presenting complaint and the students must ask the tutor for additional clinical information to progress through case resolution. For this intervention, the tutors made each step explicit to students and encouraged self-reflection on their reasoning processes. At the end of their elective, students' performances were assessed through encounters with two standardized patients and chart write-ups.Twenty-nine students participated, providing a total of 58 encounters. The overall differences in accuracy of the final diagnosis given to the patient at the end of the encounter (control 63% vs intervention 74%, p = 0.53) and of the final diagnosis mentioned in the patient chart (61% vs 70%, p = 0.58) were not statistically significant. The students in the intervention group significantly more often listed the correct diagnosis among the differential diagnoses in their charts (75% vs 97%, p = 0.02).This case-based clinical reasoning seminar intervention, designed to bring students insight into cognitive features of their reasoning, improved aspects of diagnostic competence.

OBJECTIVES: To evaluate and compare the educational impact of the University of Geneva Faculty of Medicine (UGFM) emergency medicine clerkship training with that provided by the Swiss Army medical officer cadets school (ARMY). The assessment was designed to assess students' clinical knowledge and competency in major emergency situations, ACLS (Advanced Cardiac Life Support) and ATLS (Advanced Traumatic Life Support). METHODS: Prospectively, 56 UGFM students were compared with 52 ARMY officer cadets by a multiformat pre- and post-training examination. The exam consisted of a multiple-choice questionnaire (MCQ), a standardised vignette-based oral exam (SOE) and a standardised practical cardio-pulmonary resuscitation (CPR) exercise. RESULTS: Overall, on the pre- and post-training testing, total scores improved significantly for the UGFM by 10% (from 63 to 73%) and for the ARMY by 9% (from 60 to 69%). Knowledge assessed on the MCQ improved for the UGFM by 8% (64 to 72%) but not significantly for the ARMY. Performance on the SOE improved by 10% for UGFM (54 to 64%) and the ARMY (47 to 57%) as well as performance on the CPR, which improved by 15% for UGFM (72 to 87%) and 19% for the ARMY (67 to 86%). Post-training performance indicated that, respectively, UGFM scored significantly higher than the ARMY on the MCQ (72 and 68%) and the SOE (64 and 57%) but not on the CPR. Internal reliability indexes for the MCQ, SOE and CPR were respectively 0.72, 0.86 and 0.92. Correlations between the MCQ, SOE and CPR varied between 0.07 to 0.19. CONCLUSIONS: In general, the multimethod assessment seemed to provide a complementary approach to evaluation of the trainees' competency in emergency training. Except for the ARMY MCQ performance, both training programmes seemed to be effective in improving trainees' overall knowledge and clinical performance. The trainees' performances are reviewed and discussed in terms of the specific skills assessed on the SOE, the context of the trainees' expected level of performance, the teaching and evaluation approaches, and implications in establishing the equivalence of the two programmes.

Perlormance-based examinations that use standardized-patient (SP) cases have been used to assess the clinical competence of senior medical students in seven classes (1986- 1992) at Southern Illinois University School of Medicine. Because of the length of the examinations, two or more (multiple) SPs have been used to simulate about half of the cases in each examination. An earlier study found little or no effect of using multiple SPs on the intercase reliability of checklist scores, written scores, and total scores. The present study was conducted to assess the effect of multiple SPs on the intercase reliability of SP ratings of interpersonal and communication skills. Although the ratings were not used to determine total scores or to make pass - fail decisions, it seems reasonable to expeJt that multiple SPs might have a greater impact on ratings on non-cognitive dimensions than on ostensibly more objective checklist and written scores. In general, the results showed that generalizability coefficients free of measurement error due to multiple SPs were larger than those reflecting measurement error due to multiple SPs by an average of about 5 percentage points, suggesting that the use of multiple SP raters on the same case reduced reliability by about 5 percentage points. Compared to earlier findings, the effect of multiple SPs on the reliability of ratings was about 4 or 5 times greater than their effect on checklist, written, or total scores. Nevertheless, the magnitude of the effect on ratings was not excessive.

L'évaluation de la démarche diagnostique des étudiants en médecine se base souvent sur des listes d'éléments discriminants recueillis durant une consultation médicale, déterminées par consensus d'experts ou par des modèles conceptuels (MC) tirés de la littérature. Pour comparer ces sources, nous avons étudié l'approche clinique de six cliniciens expérimentés face à une plainte principale lors de trois entretiens avec patients standardisés. Parallèlement, une recherche de littérature a permis d'établir des MC de recueil d'informations pour ces plaintes. La comparaison entre les deux approches révèle que les données sollicitées par les experts sont majoritairement discriminantes selon le MC, alors que moins de la moitié des éléments discriminants du MC sont utilisés. Les experts parviennent toutefois aux diagnostics corrects. En conclusion, les cliniciens ne suivent pas forcément l‘approche des modèles conceptuels ; la préparation de listes de critères d'évaluation des étudiants doit en tenir compte et se baser sur ces deux sources.