Exploring how students think: a new method combining think-aloud and concept mapping protocols.

OBJECTIVES: A key element of medical competence is problem solving. Previous work has shown that doctors use inductive reasoning to progress from facts to hypotheses and deductive reasoning to move from hypotheses to the gathering of confirmatory information. No individual assessment method has been designed to quantify the use of inductive and deductive procedures within clinical reasoning. The aim of this study was to explore the feasibility and reliability of a new method which allows for the rapid identification of the style (inductive or deductive) of clinical reasoning in medical students and experts. METHODS: The study included four groups of four participants. These comprised groups of medical students in Years 3, 4 and 5 and a group of specialists in internal medicine, all at a medical school with a 6-year curriculum in France. Participants were asked to solve four clinical problems by thinking aloud. The thinking expressed aloud was immediately transcribed into concept maps by one or two 'writers' trained to distinguish inductive and deductive links. Reliability was assessed by estimating the inter-writer correlation. The calculated rate of inductive reasoning, the richness score and the rate of exhaustiveness of reasoning were compared according to the level of expertise of the individual and the type of clinical problem. RESULTS: The total number of maps drawn amounted to 32 for students in Year 4, 32 for students in Year 5, 16 for students in Year 3 and 16 for experts. A positive correlation was found between writers (R = 0.66-0.93). Richness scores and rates of exhaustiveness of reasoning did not differ according to expertise level. The rate of inductive reasoning varied as expected according to the nature of the clinical problem and was lower in experts (41% versus 67%). CONCLUSIONS: This new method showed good reliability and may be a promising tool for the assessment of medical problem-solving skills, giving teachers a means of diagnosing how their students think when they are confronted with clinical problems.

Use of 10-point analogue scales to estimate dietary intake: a prospective study in patients nutritionally at-risk.

BACKGROUND & AIMS: Assessment of dietary intake using a 3-day dietary record may delay the management of undernutrition. Methods allowing a quick estimation of dietary intake are needed. We aimed to determine the feasibility of assessing dietary intake using two 10-point verbal (AVeS) and visual (AViS) analogue scales, to assess the correlations of both scales with energy intake, and to determine the accuracy of AVeS for assessing undernutrition. METHODS: We prospectively recruited 114 patients undernourished or nutritionally at-risk in two French University Hospitals. Undernutrition was defined as a Nutritional Risk Index <97.5. AVeS and AViS were performed by one interviewer and mean daily energy intake was calculated from 3-day dietary records by one dietician. RESULTS: The feasibility of AVeS and AViS was 98% and 96%, respectively. Both verbal and visual scales were statistically correlated with calculated energy intake (rho=0.66 and rho=0.74, P<0.0001), especially in undernourished patients (rho=0.82, P<0.0001, for AVeS). Sensitivity, specificity, positive and negative predictive values of an AVeS score less than 7 for assessing undernutrition were 57%, 81%, 86% and 46%, respectively. CONCLUSION: AVeS and AViS could be used for a quick assessment of dietary intake in clinical practice, particularly in undernourished in-patients. Thus, both verbal and visual analogue scales could be particularly useful for the management of hospital undernutrition.