OSCE For Clinical Reasoning Creative Community

Creative Communities are collaboratives that bring together NBME assessment experts and representatives of the broader health professions education community to solve the most complex and important challenges facing us in education and assessment. In 2022, NBME established the first Creative Community to develop incremental solutions with the goal of:

Enhancing the development and assessment of learner clinical reasoning skills
Presenting patient groups without bias or stereotypes
Minimizing group differences in learner outcomes
Enabling all institutions to better support learner skill development across the continuum of medical education and training

From 2022-2024, this Creative Community explored the use of simulation, specifically OSCEs, to assess and provide feedback on the learner’s process of clinical reasoning. Upon review of existing assessment tools, the Community noted a focus on the outcomes of clinical reasoning – if a learner reached correct or plausible conclusions. However, they do not provide insight into how learners reached that conclusion, nor can they produce feedback for learners to improve their reasoning skills.

Drawing on the expertise of NBME staff, faculty educators and students, the Community developed a novel case format to assess the behaviors of Hypothesis-Driven Information Gathering, the iterative ability to generate and refine hypotheses based on gathered information, then use those hypotheses to direct subsequent information gathering.

How can the power of community be used to assess the complexities of clinical reasoning?

Watch a short video to learn more about our collaborative exploration of clinical reasoning assessment.

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Findings and Next Steps

Initial pilot studies demonstrated that learners’ cognitive processes were aligned with the assessment design and provided initial validity evidence for this new assessment approach. This represents a significant shift towards a more nuanced and effective assessment of diagnostic reasoning skills, addressing one of the critical needs in competency-based medical education.

Although additional work is needed to refine this assessment and the developmental feedback for learners, the work provides a model for future advancements in the assessment of hard-to-measure constructs like clinical reasoning.

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Community Members

For this Creative Community, 10 Schools from across the country were represented by faculty members and students who came together as our thought partners and research collaborators.