Document Type: Short Communication


1 Digestive Disease Research Institute, Tehran University of medical Sciences, Tehran, Iran

2 Infectious Diseases and Tropical Medicine Research Center, Resistant Tuberculosis, Institute, Zahedan University of Medical Sciences, Zahedan, Iran

3 Department of Internal Medicine, School of Medicine, Shiraz University of Medical Sciences, Shiraz, Iran

4 Center for Educational Research in Medical Sciences (CERMS), Department of Medical Education, School of Medicine, Iran University of Medical Sciences, Tehran, Iran

5 Quality improvement in Clinical Education Research Center, Shiraz University of Medical Sciences, Shiraz, Iran

6 Department of Gynecology Oncology, Iran University of Medical Sciences, Tehran, Iran

7 Department of Internal Medicine, Babol University of Medical Sciences, Babol, Iran

8 Endocrinology and Metabolism Research Center, Institute of Basic and Clinical Physiology Sciences, Kerman University of Medical Sciences, Kerman, Iran

9 Department of Pediatric, Hamedan University of Medical Sciences, Hamedan, Iran

10 Zanjan Social determinants of health research center, Zanjan University of Medical Sciences, Zanjan, Iran

11 Medical Education Research Center, Health Management and Safety Promotion Research Institute, Tabriz University of Medical Sciences, Tabriz, Iran

12 Department of Surgery, Firoozgar general hospital, Iran University of Medical Sciences, Tehran, Iran

13 Pediatric Surgery Research Center (PSRC), Research Institute for Children Health (RICH), Mofid Children’s Hospital (MCH), Shahid Beheshti University of Medical Sciences (SBMU), Tehran, Iran

14 Clinical Education Research Center,Shiraz University of Medical Sciences, Shiraz, Iran

15 Medical School, University of Montreal, Montreal, Canada


Introduction: Clinical reasoning as a critical and high level of clinical
competency should be acquired during medical education, and medical
educators should attempt to assess this ability in medical students. Nowadays,
there are several ways to evaluate medical students’ clinical reasoning
ability in different countries worldwide. There are some well-known clinical
reasoning tests such as Key Feature (KF), Clinical Reasoning Problem
(CRP), Script Concordance Test (SCT), and Comprehensive Integrative
Puzzle (CIP). Each of these tests has its advantages and disadvantages. In this
study, we evaluated the reliability of combination of clinical reasoning tests
SCT, KF, CIP, and CRP in one national exam and the correlation between the
subtest scores of these tests together with the total score of the exam.
Methods: A total of 339 high ranked medical students from 60 medical
schools in Iran participated in a national exam named “Medical Olympiad”.
The ninth Medical Olympiad was held in Shahid Beheshti University of
Medical Sciences, Tehran, Iran, under the direct supervision of the Ministry
of Health and Medical Education in summer 2017. The expert group
designed a combination of four types of clinical reasoning tests to assess
both analytical and non-analytical clinical reasoning. Mean scores of SCT,
CRP, KF, and CIP were measured using descriptive statistics. Reliability
was calculated for each test and the combination of tests using Cronbach’s
alpha. Spearman’s correlation coefficient was used to evaluate the correlation
between the score of each subtest and the total score. SPSS version 21 was
used for data analysis and the level of significance was considered <0.05.
Results: The reliability of the combination of tests was 0.815. The reliability of
KF was 0.81 and 0.76, 0.80, and 0.92 for SCT, CRP, and CIP, respectively. The
mean total score was 169.921±41.54 from 240. All correlations between each
clinical reasoning test and total score were significant (P<0.001). The highest
correlation (0.887) was seen between CIP score and total score.
Conclusion: The study showed that combining different clinical reasoning
tests can be a reliable way of measuring this ability.