An evaluation of the clinical problem-solving process using a simulation technique

Abstract

Currently, research does not agree as to the extent to which medical content and problem-solving processes underlie clinical problem-solving. The results of research in this area fall into two categories: (1) clinical problem-solving is primarily dependent upon medical content specific within the case, and (2) clinical problem-solving is a skill, or series of skills, which can be applied to all clinical problems. In the study reported in this paper, seventy-one second-year medical students who had completed a 2-year, body-systems oriented curriculum were given an examination designed to measure clinical problem-solving. The results indicated that gathering data on patient history and hypotheses generation were specific skills common to clinical problem-solving, while hypotheses refinement, identification of relevant physical examinations, ordering laboratory investigations and making a diagnosis were case-related.

The presence of distinct and stable skills among students assessed for clinical competence in oncology

“…The results of a factor analysis of a single set of data cannot be definitive, although at least one other study (Harasym et al , 1980) has produced somewhat comparable conclusions. Confirmation of our results could have important implications for our understanding of the nature of clinical competence and its measurement.…”

The relationship between prior clerkship experience and student performance in medicine clerkships Implications for grading

“…Therefore, a diversity of clinical experiences could have led to higher scores on the NBME Special Examination in Medicine, but not necessarily on the locally developed examinations. Indeed, Harasym et al (1980) found that some clinical problem‐solving skills, such as history‐taking and hypothesis generation, are acquired general skills which are transferrable from one patient problem to another. By extension of Harasym's findings, these skills may also be transferrable from one specialty to another.…”

How we measure problem-solving ability

“…Harasym et al (1980) evaluated the clinical problem‐solving process and as a result of this study concluded that data gathering and hypothesis generation are specific problem‐solving skills while hypothesis refinement, physical examination, laboratory investigations and diagnosis are case dependent. The model used in this study appears to be similar to the modified essay question (MEQ) rather than to the PMP.…”