Preferred question types for computer-based assessment of clinical reasoning: a literature study

Clinical reasoning is a core competence of doctors. Therefore, the assessment of clinical reasoning of undergraduate students is an important part of medical education. Three medical universities in the Netherlands wish to develop a shared question database in order to assess clinical reasoning of undergraduate students in Computer-Based Assessments (CBA). To determine suitable question types for this purpose a literature study was carried out. Search of ERIC and PubMed and subsequent cross referencing yielded 30 articles which met the inclusion criteria of a focus on question types suitable to assess clinical reasoning of medical students and providing recommendations for their use. Script Concordance Tests, Extended Matching Questions, Comprehensive Integrative Puzzles, Modified Essay Questions/Short Answer Questions, Long Menu Questions, Multiple Choice Questions, Multiple True/False Questions and Virtual Patients meet the above-mentioned criteria, but for different reasons not all types can be used easily in CBA. A combination of Comprehensive Integrative Puzzles and Extended Matching Questions seems to assess most aspects of clinical reasoning and these question types can be adapted for use in CBA. Regardless of the question type chosen, patient vignettes should be used as a standard stimulus format to assess clinical reasoning. Further research is necessary to ensure that the combination of these question types produces valid assessments and reliable test results.