Assessing the Application of Knowledge in Clinical Problem Solving: The Structured Clinical Reasoning Examination (SCRE)

Objectives: To investigate the reliability, validity and acceptability of a Structured Clinical Reasoning Examination (SCRE). Methods: The SCRE was developed to assess year-5 students’ communication skills and ability to evaluate, understand and apply deep knowledge to structured clinical scenarios across four domains: Oral Disease; Primary Dental Care/Restorative; Child Dental Health; and, Dental Practice/Governance. The scenarios were mapped against the learning objectives for year-5 clinical competencies and the General Dental Council (GDC) learning outcomes considered essential for a “safe beginner”. Formative scenarios were constructed to enhance students’ understanding of the assessment and facilitate learning prior to the summative assessment. 151 year-5 students spent 45 minutes assimilating four structured clinical cases (one per domain), before rotating through four pairs of examiners who each independently assessed a single scenario over a ten minute period. At the conclusion of the assessment, all participants (students and examiners) were invited to complete ananonymous questionnaire on their perceptions of the SCRE in terms of acceptability, fairness and validity. SCRE examination scores and perception questionnaires were analysed to examine the reliability (G study), validity (criterion and construct), and acceptability. Results: The Generalizability coefficient was 0.846 whilts inter-examiner reliability was on average 0.669. Students’ SCRE scores positively correlated with their essay marks (r=0.476, p<0.0001), and understanding (r=0.490, p<0.004) and reflective (r=0.477, p<0.005) skills, demonstrating criterion validity. The SCRE internal structure (construct validity) was high for all scenarios. A total of 141 students and 24 examiners completed the questionnaire and the majority felt the assessment was acceptable, fair and valid. Conclusions: The SCRE provides a reliable, valid and acceptable means of assessing clinical reasoning skills at the “Shows How” level.