Evaluation of clinical reasoning in physicians and Medical students: an integrative review

ABSTRACT Introduction: The development of clinical reasoning is crucial for medical students and practitioners, as it enables quality medical practice and rational case investigation. This process combines intuitive and analytical reasoning, adapting to the complexity of cases. During medical training, students progress from formulating diagnostic hypotheses to developing “scripts” of diseases. With the technological advancements in medicine, understanding how clinical reasoning adapts is essential to ensuring high-quality healthcare. Objective: This study aims to analyze clinical reasoning assessment practices, identifying gaps and areas for improvement in evaluation methods to promote more effective curricula. Method: This study reviews the primary methods of assessing clinical reasoning in doctors and medical students. Using an integrative review methodology, articles and essays published in the last twenty years, in any language, that discussed or compared assessment tools were selected. Result: Of a total of 6,150 initially identified studies, after removing duplicates and evaluating titles and abstracts, 244 were selected. These articles underwent full reading, and a total of 122 articles were included in the review. The most commonly used methods are multiple-choice questions (MCQs), script concordance testing (SCT), and objective structured clinical examinations (OSCE), with over ten different assessment formats found and discussed. Conclusion: Assessment instruments, besides providing objective grades for students, shape behavior and are thus fundamental for the increasingly better training of doctors. Numerous methods are currently being researched, while others, such as the script concordance test, are being widely implemented. This study contributes to the effort of compiling all existing literature data and discovering which methods, in aggregate, are considered the most reliable and valid.