Clinical prioritisation questions: A novel assessment tool to encourage tolerance of uncertainty?

Abstract

Uncertainty is a common and increasingly acknowledged problem in clinical practice. Current single best answer (SBA) style assessments test areas where there is one correct answer, and as the approach to assessment impacts on the approach to learning, these exams may poorly prepare our future doctors to handle uncertainty. We therefore, need to modify our approach to assessment to emphasize reasoning and introduce the possibility of more than one ‘correct’ answer. We have developed clinical prioritization questions (CPQs), a novel formative assessment tool in which students prioritize possible responses in order of likelihood. This assessment format was piloted with a group of medical students and evaluated in comparison with the more traditional SBA question format in a team-based learning setting. Students reported that they felt ongoing use would help improve their tolerance of uncertainty (p < 0.01). Furthermore, over 80% of students felt that CPQs were more reflective of real-life clinical practice. Group based discussions were significantly longer when answering CPQs (p < 0.01), suggesting they may promote richer discourse. CPQs may have a role in formative assessment to help equip students with the skills to cope with ambiguity and strengthen clinical reasoning and decision-making. Institutions may find them more practical to implement compared with other clinical reasoning assessment tools.

Ethical approval

This study was granted ethical approval by the Medical Education Ethics Committee, Imperial College London.

Acknowledgments

The authors wish to thank Keean Schupke at FRY-IT for his help with the Practique software.

Disclosure statement

The authors have informed the journal that they agree that both Amir H. Sam and Rebecca K. Wilson completed the intellectual and other work typical of the first author. The authors report no conflicts of interest. The authors alone are responsible for the content and writing of the article.

Glossary

Clinical prioritisation question: A question format in which students rank possible answer options in order of likelihood, from most likely to least likely.

Additional information

Notes on contributors

Amir H. Sam

Amir H. Sam, PhD, FRCP, is Director of Assessment at Imperial College School of Medicine, London, UK.

Rebecca K. Wilson

Rebecca K. Wilson, MA, MBBS, is a Clinical Education Fellow at Imperial College School of Medicine, London, UK.

Martin Lupton

Martin Lupton, MA, MEd, MRCOG, is the Vice-Dean (Education) for the Faculty of Medicine at Imperial College School of Medicine, London, UK.

Colin Melville

Colin Melville, FRCA, FRCP, is Medical Director and Director, Education and Standards at the General Medical Council and Hon. Professor of Medical Education at the University of Manchester, Manchester, UK.

Omid Halse

Omid Halse, MBBS, FRCP, is Deputy Director of Phase 1 at Imperial College School of Medicine, London, UK.

Joanne Harris

Joanne Harris, MRCP, MRCGP, is Director of Medical Education, University of Buckingham, UK.

Karim Meeran

Karim Meeran, FRCP, FRCPath, is Director of Teaching at Imperial College School of Medicine, London, UK.