REACT: Rapid Evaluation Assessment of Clinical Reasoning Tool.

Autor: Peterson BD; University of Virginia Health, Charlottesville, VA, USA., Magee CD; University of Virginia School of Medicine, Charlottesville, VA, USA., Martindale JR; University of Virginia School of Medicine, Charlottesville, VA, USA., Dreicer JJ; University of Virginia School of Medicine, Charlottesville, VA, USA., Mutter MK; University of Virginia School of Medicine, Charlottesville, VA, USA., Young G; University of Virginia School of Medicine, Charlottesville, VA, USA., Sacco MJ; University of Virginia School of Medicine, Charlottesville, VA, USA., Parsons LC; University of Virginia School of Medicine, Charlottesville, VA, USA., Collins SR; University of Virginia School of Medicine, Charlottesville, VA, USA., Warburton KM; University of Virginia School of Medicine, Charlottesville, VA, USA., Parsons AS; University of Virginia School of Medicine, Charlottesville, VA, USA. asp5c@virginia.edu.
Jazyk: angličtina
Zdroj: Journal of general internal medicine [J Gen Intern Med] 2022 Jul; Vol. 37 (9), pp. 2224-2229. Date of Electronic Publication: 2022 Jun 16.
DOI: 10.1007/s11606-022-07513-5
Abstrakt: Introduction: Clinical reasoning encompasses the process of data collection, synthesis, and interpretation to generate a working diagnosis and make management decisions. Situated cognition theory suggests that knowledge is relative to contextual factors, and clinical reasoning in urgent situations is framed by pressure of consequential, time-sensitive decision-making for diagnosis and management. These unique aspects of urgent clinical care may limit the effectiveness of traditional tools to assess, teach, and remediate clinical reasoning.
Methods: Using two validated frameworks, a multidisciplinary group of clinicians trained to remediate clinical reasoning and with experience in urgent clinical care encounters designed the novel Rapid Evaluation Assessment of Clinical Reasoning Tool (REACT). REACT is a behaviorally anchored assessment tool scoring five domains used to provide formative feedback to learners evaluating patients during urgent clinical situations. A pilot study was performed to assess fourth-year medical students during simulated urgent clinical scenarios. Learners were scored using REACT by a separate, multidisciplinary group of clinician educators with no additional training in the clinical reasoning process. REACT scores were analyzed for internal consistency across raters and observations.
Results: Overall internal consistency for the 41 patient simulations as measured by Cronbach's alpha was 0.86. A weighted kappa statistic was used to assess the overall score inter-rater reliability. Moderate reliability was observed at 0.56.
Discussion: To our knowledge, REACT is the first tool designed specifically for formative assessment of a learner's clinical reasoning performance during simulated urgent clinical situations. With evidence of reliability and content validity, this tool guides feedback to learners during high-risk urgent clinical scenarios, with the goal of reducing diagnostic and management errors to limit patient harm.
(© 2022. The Author(s) under exclusive licence to Society of General Internal Medicine.)
Databáze: MEDLINE
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