Measuring the process of solving clinical diagnostic problems.

The method used by medical students to solve clinical problems is commonly measured by their ability to reach an accurate diagnosis. Rarely has attention been given to an objective measurement of the student’s approach in reaching this diagnosis. The process or approach taken by a student as he works his way through these confrontations warrants careful objective measurement if we hope to assist him in his development of the skills of problem solving. The process of reaching a diagnosis is, for the purpose of this study, defined as the steps taken or sequence used by a student as he solves a clinical problem. Specific inquiry into the process of reaching a clinical diagnosis was begun by Rimoldi, who developed a method for studying a student’s clinical problem-solving ability (Rimoldi, 196 1 ). His ‘Test of diagnostic skills’ was used by Weitman and Coisman (1965), who studied the factors which influence the training of medical students. The ability of medical students to develop and verify a hypothesis from data collected from patients was studied by use of a ‘Clinical performance record‘ developed by Cowles (Cowles and Kubany, 1959; Cowles, 1965). Williamson (1965) made an assessment of clinical judgment utilizing the Patient Management Problems which were developed at the University of Illinois. These problems assess not only the diagnosis made by the physician but also begin to measure objectively the approach that was used in solving the clinical problem. An important contribution to this field has been made by Weed (1968). His method of recording information in the medical record helps the physician to develop a more systematic and meaningful approach to clinical problems. These investigations, as well as the research described in this paper, were based on the