Clinical Reasoning and Self-confidence Assessment Tool (CRESCAT): A Preliminary Validation Study

Background: Case-based learning, a clinical reasoning inductive methodology, can be a pedagogical strategy for preclinical medical students. Self-confidence is also an essential issue in this phase of the medical course. Specific tools, such as questionnaires specially designed for this purpose, can better assess the development of these skills.

Objective: To validate a questionnaire that assesses preclinical medical students' clinical reasoning accuracy and self-confidence.

Methods: We designed the Clinical Reasoning and Self-confidence Assessment Tool (CRESCAT), which was developed and validated to measure accuracy and self-confidence. The target population is the first- and second-year medical students. The questionnaire is compounded by 7 clinical cases of commonly known diseases, with 5 to 6 questions for each case. An expert panel developed the answers’ template. A Likert scale was used to measure self-confidence. CRESCAT was applied in November 2022 to a more advanced sample than the preclinical students: Fourth-year students (4YMS, n=7) and internal medicine medical residents (IMMR, n=7). Statistical analysis included Cronbach’s alpha to determine the reliability of Likert scale answers. The Kruskal-Wallis test compared CRESCAT measures. Spearman’s correlation was applied for the primary objectives. Statistical significance was set at P < .050.

Results: We observed an increase in average accuracy from 4YMS to IMMR (65.2±2.9% and 77.7±2.3%, respectively; P= .006). Although there was no difference in self-confidence averages, a moderate correlation was found between self-confidence and accuracy (Rs = .663, P = .001). The validation population considered the CRESCAT friendly and easy to answer.

Conclusions: We tested a clinical reasoning and self-confidence assessment tool (CRESCAT) developed for preclinical medical students. It was applied to fourth-year students and medical residents, showing its potential to discriminate accuracy and correlate with self-confidence.