Assessment of Clinical Reasoning During a High Stakes Medical Student OSCE.

Background & Need For Innovation: Objective Structured Clinical Examinations (OSCEs) are commonly employed to assess clinical skills. While several existing tools address components of clinical reasoning, including the Assessment of Reasoning Tool, none are calibrated for competency-based assessment of medical students (UME) in an OSCE setting.

Goal Of Innovation: We sought to create a clinical reasoning assessment for use in a high-stakes, summative medical student OSCE.

Steps Taken For Development And Implementation Of Innovation: A minimum-competency OSCE was administered to medical students following their required clinical clerkships. We developed a tool to assess clinical reasoning of medical students at the conclusion of their required clinical clerkships and deployed it during a minimum-competency OSCE exam given at that time. The highest level of the modified tool represented minimum acceptable performance for examinees.

Evaluation Of Innovation: The scores and analyses provided evidence to support the use of this tool. Examinees' performance on clinical reasoning tasks was comparable with their overall performance on the OSCE. The sub-scores for clinical reasoning accurately distinguished successful examinees from those who did not meet the minimum performance level, providing support for the use of the tool in this high stakes setting.

Critical Reflection: This tool was found to be useful and defensible to assess medical students' clinical reasoning. Expanded evidence for generalizability of the tool and its utility in other settings will need to be garnered through multi-center implementation and study.