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Assessing Clinical Reasoning: The Development of a New Test in Psychiatric Education

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Abstract

The development of a new method of assessing diagnostic reasoning in the initial psychiatric interview is described. The University of Vermont Diagnostic Process Test is designed to obtain the clinician-subject’s open-ended responses to a segmented videotape of a psychiatric case. Protocols are content-analyzed and results quantified to produce four indices of diagnostic competence. These include the generation and the tracing of hypotheses, the justification of diagnosis and management planning, and the accuracy of diagnosis. This article reports the measurement of change in diagnostic reasoning in medical students and psychiatric residents who received educational intervention. Results of the two preliminary studies are discussed.

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References

  1. McGuire, C.H., and Babbott, D.: Simulation technique in the measurement of problem solving skills. Journal of Educational Measurement 4:1–10, 1967.

    Article  Google Scholar 

  2. McCarthy, W.H., and Gonnella, J.S.: The simulated patient management problem: A technique for evaluating and teaching clinical competence. British Journal of Medical Education 1:348–352, 1967.

    Article  CAS  PubMed  Google Scholar 

  3. Berner, E.S., Hamilton, L.A., and Best, W.R.: A new approach to evaluating problem solving in medical students. Journal of Medical Education 49:666–672, 1974.

    PubMed  CAS  Google Scholar 

  4. Leaper, D.J., Horrocks, J.C., Staniland, J.R., and deDombal, F.T.: Computer-assisted diagnosis of abdominal pain using “estimates” provided by clinicians. British Medical Journal 4:350–354, 1972.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  5. Allai, L.K.: Training of Medical Students in a Problem-Solving Skill: The Generation of Diagnostic Problem Formulations. Unpublished Ph.D. Dissertation. East Lansing, Michigan State University, 1973.

    Google Scholar 

  6. Leaper, D.J., Gill, P.W., Staniland, J.R., Horrocks, J.C., deDombal, F.T.: Clinical diagnostic process: An analysis. British Medical Journal 3:569–574, 1973.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  7. Sandifer, M.G., Hordern, A., and Green, I.M.: The psychiatric interview: The impact of the first three minutes. American Journal of Psychiatry 126:968–973, 1970.

    Article  PubMed  Google Scholar 

  8. Kendell, R.E.: Psychiatric diagnoses: A study of how they are made. British Journal of Psychiatry 122:437–445, 1973.

    Article  CAS  PubMed  Google Scholar 

  9. Barrows, H.S., Abrahamson, S.: The programmed patient: A technique for appraising student performance in clinical neurology. Journal of Medical Education 59:802–805, 1964.

    Google Scholar 

  10. Fitzhenry-Coor, I.: Developmental Social Cognitive Processes in the Clinical Interview: A Model. Paper presented at the Anual Meetings of the American Psychological Association, Toronto, Canada, 1978.

    Google Scholar 

  11. Nurcombe, B., Fitzhenry-Coor, I.: How do psychiatrists think? Clinical reasoning in the psychiatric interview: A research and education project. Australian and New Zealand Journal of Psychiatry 16:13–24, 1982.

    Article  CAS  PubMed  Google Scholar 

  12. Elstein, A.S., Shulman, L.S., Sprafka, S.A.: Medical Problem Solving: An Analysis of Clinical Reasoning. Cambridge, Harvard, 1978.

    Book  Google Scholar 

  13. Inhelder, B., Piaget, J.: The Growth of Logical Thinking from Childhood to Adolescence. New York: Basic Books, 1958.

    Book  Google Scholar 

  14. Arkes, H.: Impediments to accurate clinical judgment and possible ways to minimize their impact. Journal of Consulting and Clinical Psychology 49:323–330, 1981.

    Article  CAS  PubMed  Google Scholar 

  15. Flapan, D.: Children’s understanding of social interaction. New York, Teachers’ College Press, 1968.

    Google Scholar 

  16. Kitchener, K., King, P.: Reflective judgment: Concepts of justification and their relationship to age and education. Journal of Applied Developmental Psychology 2:89–116, 1981.

    Article  Google Scholar 

  17. Spitzer, R., Fleiss, J.: A re-analysis of the reliability of psychiatric diagnosis. British Journal of Psychiatry 125:341–347, 1974.

    Article  CAS  PubMed  Google Scholar 

  18. Livesley, N., Bromley, D.: Person perception in childhood and adolescence. New York, John Wiley, 1973.

    Google Scholar 

  19. Shatz, M.: The relationship between cognitive processes and the development of communication skills. In C.B. Keasey (ed): Nebraska Symposium on Motivation, 1977, Vol. 25. Lincoln, Nebraska, University of Nebraska Press, 1977.

    Google Scholar 

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Authors and Affiliations

  1. School of Medicine of the University of Vermont, Burlington, VT, USA

    Ina Fitzhenry-Coor Phd. (assistant professor in the Department of Psychiatry) & Barry Nurcombe MD (professor of psychiatry and director of child psychiatry in the Department of Psychiatry)

Authors
  1. Ina Fitzhenry-Coor Phd.
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  2. Barry Nurcombe MD
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Fitzhenry-Coor, I., Nurcombe, B. Assessing Clinical Reasoning: The Development of a New Test in Psychiatric Education. Acad Psychiatry 7, 183–196 (1983). https://doi.org/10.1007/BF03399885

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  • DOI: https://doi.org/10.1007/BF03399885

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