Evaluating Evidence-Informed Clinical Reasoning Proficiency in Oral Practical Examinations

Abstract

Clinical reasoning is the specific cognitive process used by health care practitioners to formulate accurate diagnoses for complex patient problems and to set up and carry out effective care. Athletic training students and practitioners need to develop and display effective clinical reasoning skills in the assessment of injury and illness as a first step towards evidence-based functional outcomes. In addition to the proper storage of and access to appropriate biomedical knowledge, an equally important component of effective clinical reasoning is the ability to select and interpret various conclusions from the mounting quantity of evidence-based medicine (EBM) sources. In assessing injury and illness, this competency is particularly reliant upon experience, skill execution, and available evidence pertaining to the diagnostic accuracy and utility of various special tests and physical examination procedures. In order to both develop and assess the ability of our students to integrate EBM into their clinical reasoning processes, we have designed exercises and evaluations that pertain to evidence-based clinical decision making during oral practical examinations in our assessment of athletic injury labs. These integrated oral practical examinations are designed to challenge our students' thinking and clinical performance by providing select key features of orthopaedic case pattern presentations and asking students to pick the most fitting diagnostic tests to fit that particular case. Students must not only match the appropriate special/functional tests, etc, to the case's key features, but also choose and explain how useful the chosen tests are for the differential diagnosis process, relative to the best diagnostic evidence. This manuscript will present a brief theoretical framework for our model and will discuss the process we use to evaluate our students' ability to properly select, perform, and explain various orthopaedic examination skills and the relevant evidence available. Specific examples of oral practical exam modules are also provided for elucidation.

Exploration of Factors Perceived to Influence Development of Diagnostic Reasoning in Athletic Trainers and Athletic Training Students

“…To date, the inner processes and clinical utility of diagnostic reasoning have been only marginally investigated in athletic training education or clinical practice. 1,2,[4][5][6][7][8][9] Athletic trainers must make accurate diagnostic decisions or impressions before implementing safe and effective plans of care, and diagnostic reasoning is a core concept of the clinician expertise component of evidence-based practice. Recently, a modicum of studies and presentations have been made available in various outlets, 3,8 but there is still much work on the topic to be carried out by educators and clinicians alike.…”