The CIP (comprehensive integrative puzzle) assessment method.

This paper describes a novel tool for assessment in medical education, the comprehensive integrative puzzle (CIP). The dual scoring system of the puzzle stresses the integrative elements of diagnostic thinking and clinical reasoning, while preserving the ability to discern proficiency in various disciplinary elements. The CIP has the format of an 'extended matching' crossword puzzle. Its answer sheet is a grid comprising rows and columns. The left-hand column contains diagnoses or brief clinical vignettes. To complete the cells of the grid the student is required to match, stepwise, the various 'disciplinary investigations' to the diagnoses or clinical vignettes. When the puzzle is completed each horizontal row reflects a coherent medical case. The completed horizontal rows reflect integrative ability (diagnostic thinking and clinical reasoning) and the vertical columns measure the student's proficiency in interpreting medical history data, physical examination findings, laboratory test results, ECG, imaging, special tests, pathology and pharmacology. The CIP has been well accepted by teachers and students during the last seven years at the Bruce Rappaport Faculty of Medicine in Haifa, and it has favorably affected both student assessment and teaching. The reliability of the test and its validity will be reported separately.