Increased student self-confidence in clinical reasoning skills associated with case-based learning (CBL)

Second-year veterinary students were surveyed at the beginning and end of a 15-week semester regarding their confidence in performing three clinical reasoning skills: (1) making Problem Lists; (2) making Rule-Out Lists; and (3) selecting appropriate diagnostic tests. Each week during the semester, these skills were practiced in small-group case discussions. Changes in self-confidence were analyzed and studied in light of faculty assessments of student competence in performance of the three skills. RATIONALE: The purpose of the study was to determine if students' self-confidence in performing three clinical reasoning skills increased with practice. METHODOLOGY: On the first and last days of class, students rated their confidence in each of the three skills on a scale of 0 to 10. Mean confidence scores for the whole class both for time points and for each of the three skills were analyzed. RESULTS: There were significant increases in students' self-confidence in all three clinical reasoning skills over the semester each year. A greater percentage of students expressed improved confidence in selecting appropriate diagnostic tests than in the other two skills in three of the four years studied. CONCLUSIONS: Students' self-confidence in performing three clinical reasoning skills improved over the course of a semester in which they practiced the skills in a CBL format. Subjective faculty assessment of students' competence in these skills generally indicated improvement. However, no meaningful conclusions about the correlation of skill competence and student confidence could be drawn because of inadequacies in the measurement of student performance.