Encouraging Critical Clinical Thinking (CCT) Skills in First-Year Veterinary Students.

First-year didactic course instructors at the University of Illinois College of Veterinary Medicine leverage earlier clinical rotation experiences with weekly "Clinical Correlations" exercises to provide early exposure to critical clinical thinking (CCT). This study evaluated the efficacy of individual and paired group exercises on CCT development. Before and after instruction, the Cornell Critical Thinking Test (Level Z) (CCTTZ) was administered. Based on the hypothesis that students with higher scores would coach lower-scoring colleagues during group exercises, heterogeneous groups with similar mean scores were established for the year. Students completed 14 individual and paired group exercises over 6 months. Exercises were designed to increase in complexity and decline in scaffolding. Seven of the exercises were cases using the Applied Learning Platform (ALP) at http://www.whenknowingmatters.com . Student analyses were scored according to a six-category critical-thinking rubric using a 5-point scale. Consistent with our hypothesis, individual and group rubric scores increased significantly, plateauing near the end of the year. Contrary to our hypothesis, mean overall CCTTZ scores did not change, but there was a small statistically significant increase in the ability to assess the validity of an argument. Student attitudes were mixed. Positive comments focused on reinforcement of prior didactic instruction, while negative comments focused on preparation time needed to conduct research on clinical concepts, and on a lack of explicit evaluation by summative examinations. Nonetheless, end-of-year GPAs correlated linearly with cumulative individual rubric scores. In summary, the value of early curriculum CCT training was confirmed when discipline-specific criteria were applied.

Peer assessment of a final-year capstone experience for formative evaluation of a pathology curriculum.

In spring of 2005, the authors implemented and evaluated a process at the Iowa State University College of Veterinary Medicine in which third-year students evaluated fourth-year students' performances on an advanced case-analysis assignment. This assignment, called the case correlation assignment, required a thorough integration and explanation of all ante- and post-mortem data for a specific hospital patient. Using a 21-point rubric, the necropsy course instructor and third-year students rated these assignments. Fourth-year students' performances on this assignment were used as an indicator of the success of the pathology curriculum. The authors evaluated the assessment process for feasibility, reliability, and validity. Many-facet Rasch analysis was used to determine item, case, and rater agreement. The assessment process produced good agreement among items and cases (VM4 student competence). Furthermore, most third-year students were able to reliably rate the case correlation assignments with no special training. The evaluation process was cost effective and occurred in the context of regular course assignments, thereby making it feasible. A case can be made that the overall process provides a valid measure of the pathology program's success in preparing students in the area of veterinary pathology.

Mechanism-based diagnostic reasoning: thoughts on teaching introductory clinical pathology.

Teaching introductory clinical pathology to veterinary students is a challenging endeavor that requires a shift in learning strategies from rote memorization to diagnostic reasoning. Educational research has identified discrete cognitive stages required to achieve the automated, unconscious thinking process used by experts. Building on this knowledge, we developed a case-based approach to clinical pathology instruction that actively engages students in the learning process and links performance with positive reward. Simulated cases provide context and create a structure, or "schema", which enhances the learning process by enabling students to synthesize facts and link them with their causal mechanism to reach a defensible diagnostic conclusion. Web-based tools, including the "Problem List Generator" and tutorials, have been developed to facilitate this process. Through the collaborative Biomedical Informatics Research Group, we are working to further develop and evaluate Web-based instructional tools and new educational methods, to clarify the diagnostic reasoning processes used by experienced clinical pathologists, and, ultimately, to better educate our future students to be effective diagnosticians.