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J Educ Eval Health Prof > Epub ahead of print
J Educ Eval Health Prof. 2019; 16: 10.
Published online May 9, 2019.
[Epub ahead of print]
How do medical students actually think while solving problems in three different types of clinical assessments in Korea: Clinical performance examination (CPX), multimedia case-based assessment (CBA), and modified essay question (MEQ)
Sejin Kim1  , Ikseon Choi1  , Bo Young Yoon2  , Min Jeong Kwon2  , Seok-jin Choi3  , Sang Hyun Kim2  , Jong-tae Lee4  , Byoung Doo Rhee2 
1Research and Innovation in Learning (RAIL) Lab, College of Education, The University of Georgia, Athens, GA, USA
2Department of Internal Medicine, College of Medicine, Inje University, Busan, Korea
3Department of Radiology, College of Medicine, Inje University, Busan, Korea
4Department of Preventive Medicine, College of Medicine, Inje University, Busan, Korea
Correspondence  Byoung Doo Rhee ,Email:
Editor:  Sun Huh, Hallym University, Korea
Submitted: April 11, 2019  Accepted after revision: May 9, 2019
This study aimed to explore students’ cognitive patterns while solving clinical problems in three different types of assessments - clinical performance examination (CPX), multimedia case-based assessment (CBA), and modified essay question (MEQ) - and thus, to understand how different types of assessments can afford different thinking.
A total of six test-performance cases from two fourth-year medical students were used for a cross-case study. Data were collected through one-on-one interviews using a stimulated recall protocol where students were: 1) shown videos of themselves taking each assessment and 2) asked to elaborate on what they were thinking. The unit of analysis was the smallest phrases or sentences, from the participants’ narratives, representing a meaningful cognitive occurrence. The narrative data were reorganized chronologically and then analyzed according to a frame of hypothetico-deductive reasoning as clinical reasoning.
Both participants demonstrated similar patterns in their proportional frequencies of clinical reasoning on the same clinical assessment. The results also revealed that the three different assessment types may afford different aspects of clinical reasoning. For example, the CPX highly promoted the participants’ reasoning related to inquiry strategy, while the MEQ highly promoted hypothesis generation. Similarly, the participants’ data analysis and synthesis were more afforded by the CBA than the other types.
This study discovered that different assessment design affords different thinking in problem-solving. This finding can contribute to leveraging ways of improving current clinical assessments. Importantly, the research method used in this study can be utilized as an alternative way of examining the validity of clinical assessments.
Keywords: Clinical performance examination; Modified essay question; Case-based assessment; Clinical assessment; Assessment validity; Republic of Korea
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