Southern Illinois University School of Medicine, Carbondale, Illinois, USA ion

Do students prepared in a Problem-Based Learning Curriculum demonstrate differences in clinical reasoning or problem-solving abilities from those prepared in a traditional lecture-based curriculum? Do differences in the styles of academic preparation have a measurable effect on patient care abilities? If so, is it a lasting effect that will persist through and beyond parallel clerkship training or merely temporary, with all students leveling out by graduation?

Southern Illinois University School of Medicine has had a dual curriculum in the first two years of medical school, a problem-based curriculum (PBL) and a traditional lecture-based curriculum (TLB), since the early 1990’s. Preliminary results from a study currently in progress indicate that PBL students use more basic science in their explanations of patient problems than do TLB students. Their descriptions are more complex and the clinical reasoning chains they develop to account for patient problems tend to be longer. Can these results be replicated and confirmed in a larger assessment context?

It has been a challenge to effectively compare performance across the two curricula because of the limitations of examination methodology. Multiple choice examinations provide a look at content knowledge, standardized patient examinations allow us to assess clinical skills and behaviors, but the assessment of clinical reasoning has been more difficult to reliably measure. Oral examinations have been used, but they are limited by faculty availability and inter-rater differences. A more reliable and measurable assessment tool for clinical reasoning that still provides the opportunity for richly constructed responses has been needed.

A multiple station clinical practice examination conducted at SIU School of Medicine since 1985 for senior medical students may provide the necessary data for answering the questions specified above. The examination is designed to assess the clinical readiness of senior students for postgraduate training, and therefore attempts to capture and assess their clinical reasoning, not just during the history and physical examination of the patient, but afterwards during the post-patient work-up. In late 1997, collaborative development began between the school and the DxR Development Group to produce a computer software program that would allow free text (constructed) responses to key clinical reasoning questions of findings-recognition, differential diagnosis, test selection/interpretation, diagnosis and management.

The resultant Clinical Competency Examination or CCX software has been used now with the Classes of 1999 and 2000 and provides a more complete look at students’ clinical reasoning processes. Differences between students from the PBL and TLB preparation groups will be presented and discussed.

Attendees will learn whether students educated in a problem-based,self-directed learning curriculum can perform as well on performance-based examinations as traditional educated students. Attendees will also have the opportunity to understand more about the benefits and challenges of administrating performance-based examinations using computer technology.

J. Hurley Myers
Southern Illinois University
School of Medicine
Carbondale, IL 62901
USA
Phone: 618 453-1140
Fax: 618 453-5309
Email: jmyers@siumed.edu
Website: http://www.dxrgroup.com

Co-Authors' Information:

Linda Morrison and Tracy Lower
Departments of Medical Education and Pediatrics
Southern Illinois University
School of Medicine
Carbondale, IL 62901
USA
Phone: Morrison: 217 782-0872
Lower: 217 557-1020
Fax: 217 524-0192
Email: lmorrison@siumed.edu
tlower@siumed.edu