Biomedical Research

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The comparison of the key feature of clinical reasoning and multiple choice examinations in clinical decision makings ability

Introduction: Clinical reasoning skills play a major role in the ability of physicians to make diagnosis and take an appropriate intervention for treatment of patients. The aim of this research is the comparison between the key features examinations and common multiple choice examinations for assessing the individuals’ clinical decision makings ability in obstetrics and gynaecology department.

Methods: In this study, 59 midwifery students were participated. After each multiple choice examination, the Key features examination was held. The correlation between these two examinations was analysed. The reliability of the Key features examination was measured by the Cronbach’s alpha values. By means of the Whitney and Sabers method, difficulty index of questions was determined; and correlation of every question with the total examination was investigated by using SPSS software. Satisfaction of clinical reasoning assessment in top students was compared with weak students by using LIKERT scale.

Results: The mean score in the key points’ examination was 10.19 out of 20 and in multiple choice examination was 8.88, there was a significant difference between these two exams’ outcomes (P=0.005). The reliability of the key points’ examination was 0.75. The correlation every question with the total examination was 0.29-0.82, and the difficulty index was 0.43-0.77. The discrimination index was 0.31-0.63. The mean correlation between the key feature and routine multiple choice questions was 0.49 (P=0.001).

Conclusion: The difficulty index, the discrimination index and the Cronbach’s alpha values suggested that clinical reasoning cannot be evaluated by the multiple choice examinations; therefore the use of the novel evaluation tools in the clinical field such as key features examination was suggested.

Author(s): Shohreh Zamani, Mitra Amini, Seyede Zahra Masoumi, Somayeh Delavari, Mohammad Javad Namaki, Javad Kojuri