As the fluorescent lights buzzed above in the crowded lecture hall, a palpable tension filled the air. Seated in rows of wooden desks, 67 optometry students grappled with an intense challenge: the Clinical Diagnosis Assessment (CDA). A moment of silence falls as the proctor announces, “Your time starts now.” For these students, each tick of the clock represents not just an exam, but a pivotal moment in their burgeoning careers.

Descriptive statistics

In the cohort of 67 students, 55 (82%) completed Diagnostic Thinking Inventory 1, while 42 (63%) took part in Diagnostic Thinking Inventory 2. Additionally, 50 students (75%) consented to the use of their assessment scores, and 17 participants (26%) engaged in focus groups following the assessment. Six students were excluded as they were repeating units. Table 2 summarizes the demographic characteristics of these participants, emphasizing the diversity and dedication within the cohort.

Statistical comparison of Clinical Diagnosis Assessment to other clinical reasoning assessments

To assess the construct validity of the Clinical Diagnosis Assessment, Pearson’s correlations were employed. These analyses compared CDA results with those from other assessments structured to evaluate clinical reasoning skills, such as examinations and Objective Structured Clinical Exams (OSCEs). Significant correlations emerged between total CDA scores and examination results from each trimester, highlighting the reliability of the CDA in reflecting students’ competencies in clinical reasoning. Of note, correlations were robust across the assessments, except for CDA3 part 1 and exam T3 (refer to Table 3).

Implications of assessment

In tandem with quantitative assessments, qualitative research offers a deeper insight into the efficacy of the CDA. The Diagnostic Thinking Inventory for Optometry was administered pre- and post-assessment to examine self-perceived diagnostic reasoning skills. Results indicated marked improvement between Inventory 1 and 2, with a statistically significant enhancement in total scores (Z = 2.930, p = 0.003, r = 0.45) and in both subdomains: Structure in Memory and Flexibility in Thinking. Notably, the Wilcoxon signed-rank test supported these findings with moderate effect sizes.

A secondary analysis using the short form of the inventory demonstrated similar outcomes, reinforcing the positive impact of the CDA on self-reported skills. The DTI for Optometry 1 showed a strong positive relationship with DTI-OS1 (r = 0.869, p < 0.01), while DTI for Optometry 2 correlated strongly with DTI-OS2 (r = 0.811, p < 0.01).

Qualitative analysis

The focus groups provided a rich tapestry of insights into how the CDA influenced students’ clinical reasoning. Four predominant themes and ten subthemes emerged, summarized in Table 5.

An authentic task prompting development of key skills required for the workplace

Students articulated a newfound understanding of the Clinical Diagnosis Assessment’s relevance to their professional roles. “I think it’s hard to learn. But you can see how valuable it’ll be,” remarked one participant. Another echoed, “Ok, I am studying optometry! I am going to see patients rather than just have my head in a book for the rest of my life…” This sentiment encapsulates their recognition of the CDA as not merely an examination, but an integral step in their practical training.

Execution of clinical reasoning strategies

As they navigated through clinical scenarios, students reported employing both Type 1 (intuitive) and Type 2 (analytical) reasoning strategies. One student described their approach: “From the start I would try to pick out the main points, the age of the patient, main presenting complaint, and then go from there.” These reflections showcase their growing adaptability in real-life clinical situations.

Exposing clinical reasoning difficulties

However, challenges persisted. Many students noted that the Clinical Diagnosis Assessment highlighted potential weaknesses in their reasoning abilities. “I realized, I don’t write or think in clinical terms. Like instead of thinking diplopia, I always think double vision,” stated one participant, demonstrating the gap between academic knowledge and clinical application.

Motivation to seek holistic feedback to improve future practice

The authenticity of the CDA fostered a strong motivation among students to seek constructive feedback. “It consolidated what I know and what I don’t know,” noted another participant. The opportunity to collaborate with peers and receive insights from qualified optometrists enriched their learning experience, further emphasizing the importance of continuous reflection and adaptation in clinical practice.

Key Insights from Focus Group Discussions

• Understanding the value of practical assessments in bridging the gap between theory and practice.
• Utilizing diverse clinical reasoning strategies to navigate complex patient cases.
• Identifying weaknesses in clinical reasoning and the need for further development in decision-making skills.
• The positive impact of peer collaboration and feedback on learning and performance.

In the end, the Clinical Diagnosis Assessment serves as a crucial pivot point for these aspiring optometrists. As they embrace both the triumphs and tribulations that accompany their assessments, students emerge not merely as knowledge holders, but as budding practitioners prepared to confront the challenges of patient care.

Source: bmcmededuc.biomedcentral.com