Factors associated with performance in clinical reasoning tests of neurological localization : a study in internal medicine residents
Loh, Kieng Wee
Date of Issue2017-08-31
Lee Kong Chian School of Medicine (LKCMedicine)
Background: Clinical Reasoning is the cognitive process of weighing clinical information together with past experience to evaluate diagnostic and management dilemmas. A variety of paper tests have been validated to assess clinical reasoning skills, but there has been a dearth of literature regarding factors influencing the development of these skills at the postgraduate level. We performed a retrospective study on Internal Medicine Residents to determine the sociodemographic and educational correlates of Clinical Reasoning in Neurological Localization. Methods: Subjects comprised of 162 Internal Medicine Residents on a three month attachment at the National Neuroscience Institute, Singapore, over a period of 2.5 years. Clinical Reasoning was assessed on the second month of their internship via two tests of Neurological Localization – Extended Matching Questions (EMQs) and Script Concordance Tests (SCTs). Data on Gender, Undergraduate Training Institution (UTI), Residency Programme and Amount of Clinical Experience were recorded, and their association with EMQ and SCT scores evaluated via univariate and multivariate analyses. Results: Univariate analysis indicated significant associations between Undergraduate Training Institution, Amount of Clinical Experience, EMQ and SCT Scores. Subsequent multivariate analyses suggested that Clinical Experience and UTI are positive predictors of EMQ Scores (adjusted R2 = 0.049, f2 = 0.052). Local Graduates also performed better than Overseas Graduates in the SCT (adjusted R2 = 0.101, f2 = 0.112), independent of other variables Conclusions: Development of Clinical Reasoning in Neurological Localization can be predicted via a two-factor model – Undergraduate Training Institution and Amount of Clinical Experience. Context specificity likely underlies the entire process.
Final Year Project (FYP)