A developmental approach to evaluating competence in clinical reasoning.

In the past two decades there has been tremendous worldwide interest in assessing the clinical competence of learners in medical education. This interest marks a philosophical shift toward greater objectivity, accountability, and predictive power in the evaluation of trainees. One of the core competencies in medical education is clinical reasoning. Because veterinary and human medical training share several similarities and differences, a review of the current state of clinical reasoning competency assessment in medical education may be useful for veterinary educators. This article covers the core competency of clinical reasoning (not other important competencies, such as physical examination or communication) and reviews research from medical education on the development of clinical reasoning and its implications for the transition from novice to expert. Four common stage-related learner difficulties are described: reduced knowledge, dispersed knowledge, tunnel vision, and the outsider. Specific approaches to measuring competence in clinical reasoning for each developmental level are recommended. Finally, two specific examples of evaluation based on a developmental approach to clinical expertise, the RIME (reporter, interpreter, manager, expert) system and the Script Concordance Test (SCT) methods, are discussed.