Assessing clinical reasoning: A method to monitor its development in a PBL curriculum

The aim of this study was to develop and trial a method to monitor the evolution of clinical reasoning in a PBL curriculum that is suitable for use in a large medical school. Termed Clinical Reasoning Problems (CRPs), it is based on the notion that clinical reasoning is dependent on the identification and correct interpretation of certain critical clinical features. Each problem consists of a clinical scenario comprising presentation, history and physical examination. Based on this information, subjects are asked to nominate the two most likely diagnoses and to list the clinical features that they considered in formulating their diagnoses, indicating whether these features supported or opposed the nominated diagnoses. Students at different levels of medical training completed a set of 10 CRPs as well as the Diagnostic Thinking Inventory, a self-reporting questionnaire designed to assess reasoning style. Responses were scored against those of a reference group of general practitioners. Results indicate that the CRPs are an easily administered, reliable and valid assessment of clinical reasoning, able to successfully monitor its development throughout medical training. Consequently, they can be employed to assess clinical reasoning skill in individual students and to evaluate the success of undergraduate medical schools in providing effective tuition in clinical reasoning.

Quantitative photoacoustic tomography from boundary pressure measurements: noniterative recovery of optical absorption coefficient from the reconstructed absorbed energy map

We describe a noniterative method for recovering optical absorption coefficient distribution from the absorbed energy map reconstructed using simulated and noisy boundary pressure measurements. The source reconstruction problem is first solved for the absorbed energy map corresponding to single- and multiple-source illuminations from the side of the imaging plane. It is shown that the absorbed energy map and the absorption coefficient distribution, recovered from the single-source illumination with a large variation in photon flux distribution, have signal-to-noise ratios comparable to those of the reconstructed parameters from a more uniform photon density distribution corresponding to multiple-source illuminations. The absorbed energy map is input as absorption coefficient times photon flux in the time-independent diffusion equation (DE) governing photon transport to recover the photon flux in a single step. The recovered photon flux is used to compute the optical absorption coefficient distribution from the absorbed energy map. In the absence of experimental data, we obtain the boundary measurements through Monte Carlo simulations, and we attempt to address the possible limitations of the DE model in the overall reconstruction procedure.