A pilot Study to develop a tool for the assesment of osteopathic student’s clinical reasoning

Introduction: At a time when osteopathy is moving towards evidence-based practice, it is becoming necessary to implement teaching methods and practices that are themselves evidence-based. There are studies on clinical reasoning in osteopathic education, and broadly in medical education, but to date none have really led to an assessment tool for clinical practice. In France, new decrees impose competency based curricula on academic institutions, forcing them to redefine new reliable assessment tools. The aim of the present study is to develop a clinical tool to assess the clinical reasoning of osteopathic student.
Methods: At CEESO Paris, we reviewed our existing tool used for the clinical assessment of students. Each item of the assessment tool was subject to a double comparison with the literature on clinical reasoning and the competencies defined by the decrees, leading to a criterion referenced tool allowing to identify the students clinical reasoning difficulties. Clinical supervisors were recruited to test this tool during the supervision of students at the CEESO Paris osteopathic clinic and to offer their feedback on this new tool during individual interview (qualitative analysis). Content validity and convergent validity of the tool were also be analyzed using questionnaire (quantitative analysis). Participants were also asked to indicate the expected achievement period for each criterion.
Results: 7 clinical supervisors volunteered. Based on quantitative analysis, the assessment tool showed good docimological qualities, except for Predictive validity. There were large discrepancies in responses regarding the expected period of success for each criterion. The qualitative analysis showed that supervisors considered the grid to be a good tool for formative assessment of clinical reasoning. It facilitated a dialogue on the difficulties encountered by the students and on the student's competencies.
Conclusion: the tool seems to be promising for the assessment of the clinical reasoning of osteopathic students. Further research is needed to assess the reliability of the tool and its relevance for the summative evaluation. It is also necessary to identify difficulties encountered by users that could bias the assessment or the monitoring of student’ progress.