August 17, 2016

Dr. Fred Dee has received a two-year research grant from the Edward J. Stemmler MD Medical Education Research Fund (National Board of Medical Examiners) entitled “Validation of a Case Diagramming Tool to Assess Higher-Order Thinking Skills”. Dr. Dee is co-principal investigator on the project with Dr. Kristi Ferguson, Director of OCRME. 

Mechanistic case diagrams (MCD) are flow diagrams that facilitate student’s understanding of how a patient’s clinical findings are derived from underlying etiology, risk factors, and pathogenic and pathophysiologic mechanisms. MCD is a web-based application that allows students, within the context of a clinical scenario, to create diagrams from predetermined lists of factors related to the case.  These diagrams can then be shown and discussed in class. These diagraming exercises have been used in Pathology Case Analysis, initially in Medical Pathology and more recently in the Mechanisms of Health and Disease, with a high level of student and facilitator satisfaction. The aims of the funded proposal will be to: 1) evaluate the validity of the diagramming exercises as a measure of higher order thinking skills, 2) compare student’s performance on diagramming exercises with student’s clinical reasoning skills; and 3) assess the reliability of diagramming exercises for use in higher stakes testing. 

During the first six months of this project, we will refine a set of 19 diagrams before re-administering them to the next class of students in MOHD (N=175 per medical school class). During the second six months of the first year, we will develop additional diagrams for higher-stakes assessment in other areas of the curriculum. During the second year of the project, a panel of experts will review the new diagrams and will engage in an iterative process to achieve agreement about the final diagrams, which will first be used as learning tools in a pilot phase and then in the final six months of the project will be used for higher-stakes assessment as part of the Carver College of Medicine’s Performance-based Assessment Program. We will then correlate student performance on these diagrams with the scores on in-course exams, USMLE Step 1 and Shelf Exams, and with the clinical reasoning component of our performance-based assessment program.

Model for Mechanistic Case Diagramming