Case based self-directed learning tool versus clinical reasoning learning sessions


Rania Ben Rabeh
Sonia Mazigh
Nada Missaoui
Sofien Atitallah
salem Yahayoui
Samir Boukthir


Introduction: Clinical reasoning (CR) is a core skill taught by medical schools. Clinical reasoning learning sessions (CRL) during hospital internship of externals in pediatrics was recently introduced in Faculty of Medicine of Tunis.

Aim: To compare a case based self-directed learning (CBSDL) tool with CRL sessions in two groups of the students assigned to pediatric internship.

Methods: We conducted a randomized trial with draw of two groups: CRL group (students who attended the CRL session) and SDL group (students who received the CBSDL tool). Main judgment criterion was the final score obtained by the student at the test of sequential management problem (SMP). A docimological analysis of SMP test was performed.

Results: The mean final score in CRL group and SDL group was 12.03±1.44 and 14.05±1.64, respectively (p<0.001). The scores obtained at the different steps of SMP test were significantly higher in SDL group. The difficulty p and discrimination D indices of the SPM test were 0.65 and 0.21, respectively. The agreement between the two correctors was very good since the intra-class correlation coefficient was 0.977. We analyzed the reliability of the test by measuring Cronbach's α coefficient which was 0.955.

Conclusion: CBSDL tool has allowed students to learn hypothetico-deductive reasoning. However, this tool must be supplemented by direct supervision at hospital internship to support CR.


Clinical reasoning, Learning, Assessment, Self-directed learning, Randomized Trial



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