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REACT: Rapid Evaluation Assessment of Clinical Reasoning Tool

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Abstract

Introduction

Clinical reasoning encompasses the process of data collection, synthesis, and interpretation to generate a working diagnosis and make management decisions. Situated cognition theory suggests that knowledge is relative to contextual factors, and clinical reasoning in urgent situations is framed by pressure of consequential, time-sensitive decision-making for diagnosis and management. These unique aspects of urgent clinical care may limit the effectiveness of traditional tools to assess, teach, and remediate clinical reasoning.

Methods

Using two validated frameworks, a multidisciplinary group of clinicians trained to remediate clinical reasoning and with experience in urgent clinical care encounters designed the novel Rapid Evaluation Assessment of Clinical Reasoning Tool (REACT). REACT is a behaviorally anchored assessment tool scoring five domains used to provide formative feedback to learners evaluating patients during urgent clinical situations. A pilot study was performed to assess fourth-year medical students during simulated urgent clinical scenarios. Learners were scored using REACT by a separate, multidisciplinary group of clinician educators with no additional training in the clinical reasoning process. REACT scores were analyzed for internal consistency across raters and observations.

Results

Overall internal consistency for the 41 patient simulations as measured by Cronbach’s alpha was 0.86. A weighted kappa statistic was used to assess the overall score inter-rater reliability. Moderate reliability was observed at 0.56.

Discussion

To our knowledge, REACT is the first tool designed specifically for formative assessment of a learner’s clinical reasoning performance during simulated urgent clinical situations. With evidence of reliability and content validity, this tool guides feedback to learners during high-risk urgent clinical scenarios, with the goal of reducing diagnostic and management errors to limit patient harm.

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Authors and Affiliations

  1. University of Virginia Health, Charlottesville, VA, USA

    Brian D. Peterson MD

  2. University of Virginia School of Medicine, Charlottesville, VA, USA

    Charles D. Magee MD, MPH, James R. Martindale Ph.D., Jessica J. Dreicer MD, M. Kathryn Mutter MD, MPH, Gregory Young MD, Melissa Jerdonek Sacco MD, MS, Laura C. Parsons MD, MPH, Stephen R. Collins MD, MSc, Karen M. Warburton MD & Andrew S. Parsons MD, MPH

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  1. Brian D. Peterson MD
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  2. Charles D. Magee MD, MPH
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  4. Jessica J. Dreicer MD
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Correspondence to Andrew S. Parsons MD, MPH.

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Peterson, B.D., Magee, C.D., Martindale, J.R. et al. REACT: Rapid Evaluation Assessment of Clinical Reasoning Tool. J GEN INTERN MED 37, 2224–2229 (2022). https://doi.org/10.1007/s11606-022-07513-5

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  • DOI: https://doi.org/10.1007/s11606-022-07513-5